Basic Information
Provider Information
NPI: 1003010539
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STEWART
FirstName: RICHARD
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 18667
Address2:  
City: ERLANGER
State: KY
PostalCode: 410180667
CountryCode: US
TelephoneNumber: 8595723617
FaxNumber: 8595722366
Practice Location
Address1: 85 N GRAND AVE
Address2:  
City: FORT THOMAS
State: KY
PostalCode: 410751793
CountryCode: US
TelephoneNumber: 8595723617
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/11/2007
LastUpdateDate: 05/07/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000X34008638OHN Allopathic & Osteopathic PhysiciansEmergency Medicine 
207P00000X03339KYY Allopathic & Osteopathic PhysiciansEmergency Medicine 

ID Information
IDTypeStateIssuerDescription
00000029173601OHBCBSOTHER
277479805OH MEDICAID
710018224005KY MEDICAID
20104771005IN MEDICAID


Home