Healthcare Provider Details

I. General information

NPI: 1073768917
Provider Name (Legal Business Name): BRUCE ANDREW STEWART M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2008
Last Update Date: 05/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 N 120TH AVE
HOLLAND MI
49424
US

IV. Provider business mailing address

370 N 120TH AVE R
HOLLAND MI
49424-2196
US

V. Phone/Fax

Practice location:
  • Phone: 616-396-5855
  • Fax: 616-396-5720
Mailing address:
  • Phone: 616-396-5855
  • Fax: 616-396-5720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberM9678
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number4301093528
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4301093528
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: