Provider Demographics
NPI:1801892856
Name:STEWART, ROBERT CALVERT (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CALVERT
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 1:100 E LIBERTY ST STE 800
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1428
Mailing Address - Country:US
Mailing Address - Phone:502-366-1090
Mailing Address - Fax:502-366-1564
Practice Address - Street 1:4402 CHURCHMAN AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1190
Practice Address - Country:US
Practice Address - Phone:502-366-1090
Practice Address - Fax:502-366-1564
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY30613174400000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYF80628OtherUNIQUE PROVIDER ID#
KY64306137Medicaid
IN01044681AOtherIN MEDICAL LICENSE #
KYP01026556OtherMEDICARE RAILROAD
IN100375540AMedicaid
KY30613OtherKY MEDICAL LICENSE #
KYK029590Medicare Oscar/Certification
KYF80628OtherUNIQUE PROVIDER ID#
KYP01026556OtherMEDICARE RAILROAD
KYK004112OtherCHAMPUS PROVIDER #
IN01044681AOtherIN MEDICAL LICENSE #
KY1156103Medicare ID - Type UnspecifiedKY MEDICARE PROVIDER #
KYK029590Medicare Oscar/Certification
IN100375540AMedicaid