Provider Demographics
NPI:1548245244
Name:STEWART, CHRISTAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTAN
Middle Name:
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 1:1613 KAMER DR
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-8601
Mailing Address - Country:US
Mailing Address - Phone:502-802-5984
Mailing Address - Fax:502-732-8553
Practice Address - Street 1:1911 HWY 227
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:KY
Practice Address - Zip Code:41008-8037
Practice Address - Country:US
Practice Address - Phone:502-287-6725
Practice Address - Fax:502-732-8553
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32540207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY200863970OtherANTHEM IN MCD- NORTON
KY200863970OtherMD WISE- NORTON
IN200863970Medicaid
KY2838686000OtherPASSADVANTAGE FOR NCMA
KY64325400Medicaid
KY000000507551OtherANTHEM FOR NCMA
KY110197852OtherRRMCR FOR NCMA
KY000023026EOtherHUMANA- NORTON
KY1879062OtherCIGNA- NORTON
KY089392OtherSIHO- NORTON
KY50014610OtherPASSPORT FOR NCMA
KY000000507551OtherANTHEM FOR NCMA
IN200863970Medicaid