Provider Demographics
NPI:1962690065
Name:STEWART, PHILLIP CHARLES (PA-C)
Entity type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:CHARLES
Last Name:STEWART
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1950 NORTHWESTERN AVE S
Mailing Address - Street 2:STE 102
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-7615
Mailing Address - Country:US
Mailing Address - Phone:651-430-3800
Mailing Address - Fax:651-430-3827
Practice Address - Street 1:1835 COUNTY ROAD C W STE 150
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-1343
Practice Address - Country:US
Practice Address - Phone:651-430-3800
Practice Address - Fax:651-430-3827
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2021-03-11
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Provider Licenses
StateLicense IDTaxonomies
MN1068363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant