Provider Demographics
NPI:1114998226
Name:STEWART, ELIZABETH E (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:E
Last Name:STEWART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 BENEDICTA AVE
Mailing Address - Street 2:
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082-2099
Mailing Address - Country:US
Mailing Address - Phone:719-846-2206
Mailing Address - Fax:
Practice Address - Street 1:400 BENEDICTA AVE
Practice Address - Street 2:SUITE A
Practice Address - City:TRINIDAD
Practice Address - State:CO
Practice Address - Zip Code:81082-2099
Practice Address - Country:US
Practice Address - Phone:719-846-2206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0056640207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO55684211Medicaid
IL036099315Medicaid
IL819300020Medicare PIN
IL216225Medicare PIN
G94839Medicare UPIN
IL216225002Medicare PIN