Provider Demographics
NPI:1154328474
Name:STEWART, KATHRYN J (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:J
Last Name:STEWART
Suffix:
Gender:F
Credentials:MD, MPH
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Mailing Address - Street 1:907 SOUTH BLVD
Mailing Address - Street 2:#3
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2864
Mailing Address - Country:US
Mailing Address - Phone:773-257-2800
Mailing Address - Fax:773-257-5839
Practice Address - Street 1:1508 S CALIFORNIA AVE
Practice Address - Street 2:K-943
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-1729
Practice Address - Country:US
Practice Address - Phone:773-257-2800
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC02623Medicare UPIN