Provider Demographics
NPI:1184111858
Name:STEWART, WYMAN DAVID II
Entity type:Individual
Prefix:
First Name:WYMAN
Middle Name:DAVID
Last Name:STEWART
Suffix:II
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 1:9048 HAZELTON
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-1136
Mailing Address - Country:US
Mailing Address - Phone:313-623-2848
Mailing Address - Fax:
Practice Address - Street 1:1403 INKSTER RD
Practice Address - Street 2:
Practice Address - City:INKSTER
Practice Address - State:MI
Practice Address - Zip Code:48141-1831
Practice Address - Country:US
Practice Address - Phone:313-565-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-18
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator