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NPI Code Detail

MEDICARE: STEWARD MEDICAL GROUP, INC.

MEDICARE: STEWARD MEDICAL GROUP, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician
2207R00000XInternal Medicine Physician
3207RC0000XCardiovascular Disease Physician
4207RI0011XInterventional Cardiology Physician
5207RP1001XPulmonary Disease Physician
6207V00000XObstetrics & Gynecology Physician
7208600000XSurgery Physician
8208800000XUrology Physician

General Provider Information

NPI Number : 1104367630
Entity Type Code : Organization
Provider Name (Legal Business Name) : STEWARD MEDICAL GROUP, INC.
Provider Business Mailing Address
First Line : 9 GALEN ST
Second Line :
City : WATERTOWN
State : MA
Zip : 02472-4515
Country : US
Telephone Number : 617-562-5359
Fax Number :
Provider Business Practice Location Address
First Line : 1317 W POINT DR
Second Line :
City : COCOA
State : FL
Zip : 32922-6464
Country : US
Telephone Number : 615-467-4158
Fax Number : 615-467-1267
Authorized Official
Title or Position : CFO
Name : ASHLEY KOCH
Credential :
Telephone Number : 617-562-5359
Provider Enumeration Date : 03/16/2017
Last Update Date : 08/13/2020

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