Provider Demographics
NPI:1265410856
Name:STEWART, MARK G (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:G
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 1:520 VALLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6194
Mailing Address - Country:US
Mailing Address - Phone:309-762-3621
Mailing Address - Fax:309-762-3690
Practice Address - Street 1:520 VALLEY VIEW DR
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6152
Practice Address - Country:US
Practice Address - Phone:309-762-3621
Practice Address - Fax:309-762-3690
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036098447207X00000X
IA36159207X00000X
NY220756-1207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA578210022OtherMEDICARE PTAN
IA01C2OtherJOHN DEERE FAMILY
ILK18135OtherMEDICARE PTAN
IL8121085OtherBCBS
94370OtherWELLMARK
IA0592337Medicaid
247584OtherMIDLANDS CHOICE
39336OtherWELLMARK
526253OtherIA HEALTH SOLUTIONS
91946OtherWELLMARK
91947OtherWELLMARK
IL036098447Medicaid
107468OtherHEALTH ALLIANCE
IL01B9OtherJOHN DEERE FAMILY
P00244895OtherRR MEDICARE
39336OtherWELLMARK