Provider Demographics
NPI:1336132943
Name:GARNEAU, STEWART CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:STEWART
Middle Name:CHARLES
Last Name:GARNEAU
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 1:4362 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6867
Mailing Address - Country:US
Mailing Address - Phone:309-277-2900
Mailing Address - Fax:309-277-0090
Practice Address - Street 1:4362 7TH ST
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6867
Practice Address - Country:US
Practice Address - Phone:309-277-2900
Practice Address - Fax:309-277-0090
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036055117207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036055117Medicaid
IA1932632Medicaid
IL364155168OtherAETNA
IL364155168OtherHUMANA
IA92618OtherBLUE CROOS BLUE SHIELD OF IOWA
IL08108636OtherBLUE CROSS BLUE SHIELD OF ILLINOIS
IL83004502OtherRAILROAD MEDICARE
IL364155168OtherUNITEDHEALTH CARE
IL364155168OtherAETNA
IA1932632Medicaid