Provider Demographics
NPI:1790586618
Name:STEWART, ZACHERY
Entity type:Individual
Prefix:
First Name:ZACHERY
Middle Name:
Last Name:STEWART
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 ELLENDALE PKWY
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-4343
Mailing Address - Country:US
Mailing Address - Phone:219-226-5056
Mailing Address - Fax:
Practice Address - Street 1:315 ELLENDALE PKWY
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-4343
Practice Address - Country:US
Practice Address - Phone:219-226-5056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program