Provider Demographics
NPI:1366421307
Name:STEWART, MICHAEL G (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:G
Last Name:STEWART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1305 YORK AVENUE
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021
Mailing Address - Country:US
Mailing Address - Phone:646-962-6673
Mailing Address - Fax:212-746-8549
Practice Address - Street 1:1305 YORK AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-9800
Practice Address - Country:US
Practice Address - Phone:646-962-6673
Practice Address - Fax:212-746-8549
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2024-03-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY236735174400000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02672484Medicaid
NY02672484Medicaid
NYF05853Medicare UPIN