Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 01025693A | IN |
NPI | 1053418442 |
---|---|
Provider Name | Willie F Stewart |
First Address | Chicago, IL 60615-3014 |
Second Address | Michigan City, IN 46360-4358 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D69638 | (02) |