Provider Demographics
NPI:1235100249
Name:STEWART, MICHAEL FREDERICK (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:FREDERICK
Last Name:STEWART
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 1:1217 COLUMBIA DR
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-2391
Mailing Address - Country:US
Mailing Address - Phone:478-453-7516
Mailing Address - Fax:478-453-9322
Practice Address - Street 1:1217 COLUMBIA DR
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-2391
Practice Address - Country:US
Practice Address - Phone:478-453-7516
Practice Address - Fax:478-453-9322
Is Sole Proprietor?:No
Enumeration Date:2006-01-28
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA34062208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00456189AMedicaid
202303OtherBCBS
GA334396OtherWELLCARE
B08456Medicare UPIN
34BDBLVMedicare PIN