Provider Demographics
NPI:1285615336
Name:STEWART, DANA Y (MD)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:Y
Last Name:STEWART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 W SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-5148
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1907 W SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-5148
Practice Address - Country:US
Practice Address - Phone:317-583-3332
Practice Address - Fax:317-583-2805
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060986A208000000X, 2080A0000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1144513375Medicaid
IN7446741OtherAETNA
IN200528200Medicaid
IN000000543815OtherANTHEM
IN7446741OtherAETNA
INM400044967Medicare PIN
IN251460EMedicare PIN
IN170710MMedicare PIN
IN200528200Medicaid