Provider Demographics
NPI:1396763728
Name:STEWART, TODD JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:JAMES
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 1:3009 N BALLAS RD STE 320A
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2324
Mailing Address - Country:US
Mailing Address - Phone:314-991-7707
Mailing Address - Fax:314-432-2564
Practice Address - Street 1:3009 N BALLAS RD STE 320A
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2324
Practice Address - Country:US
Practice Address - Phone:314-991-7707
Practice Address - Fax:314-432-2564
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000157510207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO025010253Medicaid
MO025010253Medicaid
MO025010253Medicare PIN
MOP00097444Medicare PIN