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NPI Code Detail

MEDICARE: DR. KATHRYN J STEWART MD, MPH

MEDICARE: DR. KATHRYN J STEWART MD, MPH
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 PhysicianIL

General Provider Information

NPI Number : 1154328474
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KATHRYN J STEWART MD, MPH
Provider Business Mailing Address
First Line : 907 SOUTH BLVD
Second Line : #3
City : OAK PARK
State : IL
Zip : 60302-2864
Country : US
Telephone Number : 773-257-2800
Fax Number : 773-257-5839
Provider Business Practice Location Address
First Line : 1508 S CALIFORNIA AVE
Second Line : K-943
City : CHICAGO
State : IL
Zip : 60608-1729
Country : US
Telephone Number : 773-257-2800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2005
Last Update Date : 07/08/2007

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