MEDICARE: MR. KENNETH STEWART M.A. F-AAA

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
1	237600000X	Audiologist-Hearing Aid Fitter	23002245A	IN

General Provider Information

NPI Number	:	1487799045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KENNETH STEWART M.A. F-AAA

Provider Business Mailing Address
First Line	:	5933 E STATE BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-7636
Country	:	US
Telephone Number	:	260-485-1231
Fax Number	:	260-486-6958

Provider Business Practice Location Address
First Line	:	5933 E STATE BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815
Country	:	US
Telephone Number	:	260-485-1231
Fax Number	:	260-486-6958

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	07/17/2018

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