Healthcare Provider Details

I. General information

NPI: 1255340329
Provider Name (Legal Business Name): IKE CHRISTOPHER STEWART M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2006
Last Update Date: 04/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 W WESMARK BLVD
SUMTER SC
29150-1977
US

IV. Provider business mailing address

325 BROAD ST STE 100
SUMTER SC
29150-4167
US

V. Phone/Fax

Practice location:
  • Phone: 803-773-5227
  • Fax: 803-774-3224
Mailing address:
  • Phone: 803-773-5227
  • Fax: 803-774-3224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number27925
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: