Provider Demographics
NPI:1851374383
Name:STEWART, JOHN H IV (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:H
Last Name:STEWART
Suffix:IV
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 1:840 S WOOD ST
Mailing Address - Street 2:MC 958
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1801 W TAYLOR ST
Practice Address - Street 2:OCC-3F
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-355-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361471752086X0206X
NC2004013352086X0206X
IL036-147175208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ01335Medicaid
7073680OtherAETNA
NC89137Y9Medicaid
WV3810001643Medicaid
D7081OtherMEDCOST
P00253280OtherRR MEDICARE
IL036147175Medicaid
VA10139899Medicaid
137Y9OtherBCBS
804840OtherPARTNERS
D7081OtherMEDCOST