Provider Demographics
NPI:1225254915
Name:STEWART, ANITA A (MD)
Entity Type:Individual
Prefix:MISS
First Name:ANITA
Middle Name:A
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 1:636 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-1065
Mailing Address - Country:US
Mailing Address - Phone:773-224-7149
Mailing Address - Fax:708-596-2258
Practice Address - Street 1:121 W 154TH ST
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426-3552
Practice Address - Country:US
Practice Address - Phone:708-339-6095
Practice Address - Fax:708-596-2258
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2080H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080H0002XAllopathic & Osteopathic PhysiciansPediatricsHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD15957Medicare UPIN
IL600990Medicare ID - Type Unspecified