Provider Demographics
NPI:1033760129
Name:STEWART, MICHELLE DENISE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DENISE
Last Name:STEWART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3369 DELBROOK DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-1130
Mailing Address - Country:US
Mailing Address - Phone:937-972-1022
Mailing Address - Fax:
Practice Address - Street 1:3369 DELBROOK DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-1130
Practice Address - Country:US
Practice Address - Phone:937-972-1022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0199864Medicaid
OHP10005354511OtherOHIO BUCKEYE