Provider Demographics
NPI:1205877479
Name:STEWART, DANIEL PATRICK (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:PATRICK
Last Name:STEWART
Suffix:
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 1:125 S KALAMAZOO MALL
Mailing Address - Street 2:SUITE 204
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-4832
Mailing Address - Country:US
Mailing Address - Phone:269-343-3900
Mailing Address - Fax:269-343-5640
Practice Address - Street 1:5352 BECKLEY RD STE B
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-4155
Practice Address - Country:US
Practice Address - Phone:269-979-6888
Practice Address - Fax:269-979-6809
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301049356207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1205877479Medicaid
MI10/2750467Medicaid
MI10/2698732Medicaid
MI10/4687059Medicaid
MI700C910950OtherBCBSM
MI10/4687059Medicaid
MIP08090011Medicare ID - Type UnspecifiedALLEGAN
MI10/2750467Medicaid
MI700C910950OtherBCBSM
MI1205877479Medicaid