Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0105X | Surgery of the Hand | 036101783 | IL |
NPI | 1427039197 |
---|---|
Provider Name | Dr. Patrick Kyle Stewart |
First Address | Mattoon, IL 61938-4653 |
Second Address | Effingham, IL 62401-2191 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2005 |
Last Update Date | 14/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036101783 | (05) | IL |