Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 24267 | WI |
Y | 208600000X | Surgeon | 24267 | WI |
NPI | 1003848458 |
---|---|
Provider Name | Gary W. Stewart |
First Address | Milwaukee, WI 53209-2042 |
Second Address | Menomonee Falls, WI 53051-2810 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 24/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30741300 | (05) | WI |
B56883 | (02) | WI |
P00451319 | RR MEDICARE (01) | WI |