Provider Demographics
NPI:1043292840
Name:STUART, MEREDITH B (DPM)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:B
Last Name:STUART
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16087 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:ELLISVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2103
Mailing Address - Country:US
Mailing Address - Phone:636-230-3883
Mailing Address - Fax:636-230-3884
Practice Address - Street 1:16087 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:ELLISVILLE
Practice Address - State:MO
Practice Address - Zip Code:63011-2103
Practice Address - Country:US
Practice Address - Phone:636-230-3883
Practice Address - Fax:636-230-3884
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI9410M1973213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU31206Medicare UPIN