Provider Demographics
NPI:1669861589
Name:HARSANT, STEWART DAVID (PA-C)
Entity Type:Individual
Prefix:
First Name:STEWART
Middle Name:DAVID
Last Name:HARSANT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1702 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-5424
Mailing Address - Country:US
Mailing Address - Phone:773-770-4056
Mailing Address - Fax:
Practice Address - Street 1:1702 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-5424
Practice Address - Country:US
Practice Address - Phone:773-770-4056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UNSPECIFIEDOtherUNSPECIFIED