Healthcare Provider Details

I. General information

NPI: 1518171073
Provider Name (Legal Business Name): MAYWOOD MEDICAL AND INDUSTRIAL CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 02/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 N MACOMB ST
MONROE MI
48162-3078
US

IV. Provider business mailing address

811 N MACOMB ST
MONROE MI
48162-3078
US

V. Phone/Fax

Practice location:
  • Phone: 734-243-2300
  • Fax: 734-243-2490
Mailing address:
  • Phone: 734-243-2300
  • Fax: 734-243-2490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. HYUN A STEWARD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 734-242-9000