Provider Demographics
NPI:1962812149
Name:STEWARD MEDICAL GROUP EXPRESS CARE, INC
Entity type:Organization
Organization Name:STEWARD MEDICAL GROUP EXPRESS CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF STEWARD MEDICAL GROUP
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-419-4718
Mailing Address - Street 1:500 BOYLSTON ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-3740
Mailing Address - Country:US
Mailing Address - Phone:617-419-4700
Mailing Address - Fax:
Practice Address - Street 1:500 BOYLSTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3740
Practice Address - Country:US
Practice Address - Phone:617-419-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEWARD MEDICAL GROUP, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-28
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty