Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | MS043841 | MI |
NPI | 1205805579 |
---|---|
Provider Name | Dr. Mark C Stewart |
First Address | Bay City, MI 48708-6476 |
Second Address | Bay City, MI 48708-6476 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2006 |
Last Update Date | 23/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
173591110 | (05) | MI |
E30917 | (02) | MI |