Healthcare Provider Details

I. General information

NPI: 1407150089
Provider Name (Legal Business Name): MICHAEL SCOTT STEWART M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2010
Last Update Date: 07/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 GROVE RD NEONATOLOGY DIVISION
GREENVILLE SC
29605-4210
US

IV. Provider business mailing address

701 GROVE RD NEONATOLOGY DIVISION
GREENVILLE SC
29605-4210
US

V. Phone/Fax

Practice location:
  • Phone: 864-455-7939
  • Fax:
Mailing address:
  • Phone: 864-455-7939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberMD36577
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: