Provider Demographics
NPI:1417248766
Name:STEWARD, PAUL WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:WAYNE
Last Name:STEWARD
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 1:1207 HILLTOP DR
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:IN
Mailing Address - Zip Code:46356-2416
Mailing Address - Country:US
Mailing Address - Phone:219-696-8190
Mailing Address - Fax:
Practice Address - Street 1:1207 HILLTOP DR
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:IN
Practice Address - Zip Code:46356-2416
Practice Address - Country:US
Practice Address - Phone:219-696-8190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01020874A208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN02095AOtherMEDICAL LICENSE AUTHORIZATION CODE
IN02095AOtherMEDICAL LICENSE AUTHORIZATION CODE