Provider Demographics
NPI:1265965958
Name:STEWART, LUKE MITCHELL (MD)
Entity type:Individual
Prefix:
First Name:LUKE
Middle Name:MITCHELL
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 1:625 19TH ST S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1900
Mailing Address - Country:US
Mailing Address - Phone:205-934-2006
Mailing Address - Fax:205-934-0024
Practice Address - Street 1:101 WILLIAM H JOHNSON ST STE 100
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2771
Practice Address - Country:US
Practice Address - Phone:843-777-7043
Practice Address - Fax:843-777-7041
Is Sole Proprietor?:No
Enumeration Date:2017-04-10
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC906732086S0129X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program