Healthcare Provider Details

I. General information

NPI: 1073803599
Provider Name (Legal Business Name): MELISSA KAY STEWART MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2011
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5656 KELLEY ST
HOUSTON TX
77026-1967
US

IV. Provider business mailing address

660 S EUCLID AVE MSC 8109-43-1160
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 713-566-5095
  • Fax:
Mailing address:
  • Phone: 314-747-2829
  • Fax: 888-824-2176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2018015287
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberT8362
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberT8362
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number2018015287
License Number StateMO
# 5
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberT8362
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: