Provider Demographics
NPI:1508848490
Name:STEWART, ELIZABETH A (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
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:PO BOX 23340
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63156-3340
Mailing Address - Country:US
Mailing Address - Phone:618-234-0640
Mailing Address - Fax:314-851-4475
Practice Address - Street 1:2900 FRANK SCOTT PKWY W
Practice Address - Street 2:SUITE 904
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62223-5000
Practice Address - Country:US
Practice Address - Phone:618-234-0640
Practice Address - Fax:314-851-4475
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036067867207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036067867OtherILLINOIS PUBLIC AID
IL118517OtherHEALTHLINK
IL036067867Medicaid
IL132702OtherBCBS TRI ST
IL5812269OtherAETNA
IL000000010038OtherESSENCE
IL0455346OtherUHC
IL127482OtherGHP
ILE20962OtherMERCY
IL132702OtherBCBS TRI ST
IL127482OtherGHP
IL036067867Medicaid