Provider Demographics
NPI:1619997251
Name:SLOAN, STEWART ELLIOT (MD)
Entity Type:Individual
Prefix:DR
First Name:STEWART
Middle Name:ELLIOT
Last Name:SLOAN
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 1:6751 N 72ND ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68122-1746
Mailing Address - Country:US
Mailing Address - Phone:402-572-3737
Mailing Address - Fax:402-572-3415
Practice Address - Street 1:6751 N 72ND ST
Practice Address - Street 2:SUITE 210
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68122-1746
Practice Address - Country:US
Practice Address - Phone:402-572-3737
Practice Address - Fax:402-572-3415
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12722208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA7189928Medicaid
IA8189928Medicaid
NE35718OtherNEBRASKA BCBS
IA98985OtherWELLMARK BCBS OF IOWA
NE47084512301Medicaid
IA8189928Medicaid
NE47084512301Medicaid
IA98985OtherWELLMARK BCBS OF IOWA
NE275370Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER #
IA340020094Medicare ID - Type UnspecifiedRAILROAD MEDICARE