Provider Demographics
NPI:1083718258
Name:STEWARD, DONALD C (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:C
Last Name:STEWARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N5330 LEDGETOP DR
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-9668
Mailing Address - Country:US
Mailing Address - Phone:920-922-4877
Mailing Address - Fax:
Practice Address - Street 1:375 EAST AVE
Practice Address - Street 2:
Practice Address - City:LOMIRA
Practice Address - State:WI
Practice Address - Zip Code:53048
Practice Address - Country:US
Practice Address - Phone:920-907-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI27332208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30651500Medicaid
WI30651500Medicaid