=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285615336
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANA Y STEWART MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2005
-----------------------------------------------------
Last Update Date | 08/27/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1907 W SYCAMORE ST
-----------------------------------------------------
City | KOKOMO
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46901-5148
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-583-3332
-----------------------------------------------------
Fax | 317-583-2805
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1907 W SYCAMORE ST
-----------------------------------------------------
City | KOKOMO
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46901-5148
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 01060986A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2080A0000X
-----------------------------------------------------
Taxonomy Name | Pediatric Adolescent Medicine Physician
-----------------------------------------------------
License Number | 01060986A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number | 01060986A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------