Provider Demographics
NPI:1205805579
Name:STEWART, MARK C (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:C
Last Name:STEWART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4 COLUMBUS AVE STE 360
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-6476
Mailing Address - Country:US
Mailing Address - Phone:989-894-1111
Mailing Address - Fax:989-894-2994
Practice Address - Street 1:4 COLUMBUS AVE STE 360
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-6476
Practice Address - Country:US
Practice Address - Phone:989-894-1111
Practice Address - Fax:989-894-2994
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIMS043841204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI173591110Medicaid
MIE30917Medicare UPIN