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General NPI Number Information
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NPI Number | 1902347438
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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 | 03/16/2017
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Last Update Date | 08/13/2020
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Provider Practice Location Address
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Address Line | 7264 WARREN SHARON RD
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City | BROOKFIELD
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State | OH
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Zip | 44403-9691
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Country | US
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Telephone | 615-467-4158
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Fax | 615-467-1267
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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 | 617-562-5359
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | ASHLEY KOCH
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Credential |
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Telephone | 617-562-5359
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine 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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #7
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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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Taxonomy #8
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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 #9
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Taxonomy Code | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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