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General NPI Number Information
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NPI Number | 1104496819
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Entity Type | Organization
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Legal Business Name | STEWARD MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 06/26/2021
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Last Update Date | 07/14/2021
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Provider Practice Location Address
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Address Line | 7100 W 20TH AVE STE 107
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City | HIALEAH
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State | FL
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Zip | 33016-1813
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Country | US
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Telephone | 305-823-8510
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Fax |
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Provider Business Mailing Address
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Address Line | 9 GALEN ST
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City | WATERTOWN
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State | MA
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Zip | 02472-4515
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Country | US
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Telephone | 617-562-5628
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Fax |
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Authorized Official
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Title or Position | PRESIDENT OF STEWARD MEDICAL GROUP
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Name | AMY GUAY
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Credential |
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Telephone | 617-562-5628
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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