Provider Demographics
NPI:1255600300
Name:STEWARD MEDICAL GROUP, INC
Entity type:Organization
Organization Name:STEWARD MEDICAL GROUP, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-419-4702
Mailing Address - Street 1:500 BOYLSTON ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-3740
Mailing Address - Country:US
Mailing Address - Phone:617-419-4700
Mailing Address - Fax:
Practice Address - Street 1:500 BOYLSTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3740
Practice Address - Country:US
Practice Address - Phone:615-467-4158
Practice Address - Fax:615-467-1267
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEWARD HEALTHCARE SYSTEM LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-19
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty