Provider Demographics
NPI:1255340329
Name:STEWART, IKE CHRISTOPHER (MD)
Entity type:Individual
Prefix:DR
First Name:IKE
Middle Name:CHRISTOPHER
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 1:325 BROAD ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4167
Mailing Address - Country:US
Mailing Address - Phone:803-773-5227
Mailing Address - Fax:803-774-3224
Practice Address - Street 1:308 W WESMARK BLVD
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-1977
Practice Address - Country:US
Practice Address - Phone:803-773-5227
Practice Address - Fax:803-774-3224
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-06
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27925207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC279255Medicaid
SCP00474993OtherRR MEDICARE PIN
SC7477Medicare PIN
SCP00474993OtherRR MEDICARE PIN