Provider Demographics
NPI:1568666592
Name:STEWART, MICHELE ANNETTE (MD)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:ANNETTE
Last Name:STEWART
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:8950 VILLA LA JOLLA DR
Mailing Address - Street 2:SUITE A-215
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1714
Mailing Address - Country:US
Mailing Address - Phone:858-457-2088
Mailing Address - Fax:858-457-2194
Practice Address - Street 1:8950 VILLA LA JOLLA DR
Practice Address - Street 2:SUITE A-215
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1714
Practice Address - Country:US
Practice Address - Phone:858-457-2088
Practice Address - Fax:858-457-2194
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2016-02-28
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Provider Licenses
StateLicense IDTaxonomies
CAC362182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC36218OtherCALIFORNIA MEDICAL LICENSE