Provider Demographics
NPI:1144229238
Name:STEWART, DAN L (MD)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:L
Last Name:STEWART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1040 SIERRA DRIVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-7241
Mailing Address - Country:US
Mailing Address - Phone:317-528-4284
Mailing Address - Fax:317-865-8355
Practice Address - Street 1:1630 LAFAYETTE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-1090
Practice Address - Country:US
Practice Address - Phone:765-361-1234
Practice Address - Fax:765-361-2267
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2014-06-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01071006A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201088910Medicaid
INM471400004OtherMEDICARE PROVIDER PTAN