Provider Demographics
NPI:1699220178
Name:STEWART, CHRISTOPHER
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:STEWART
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12991 UPTON RD
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:MI
Mailing Address - Zip Code:48808
Mailing Address - Country:US
Mailing Address - Phone:517-641-4345
Mailing Address - Fax:
Practice Address - Street 1:12991 UPTON RD
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:MI
Practice Address - Zip Code:48808-9436
Practice Address - Country:US
Practice Address - Phone:517-641-4345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator