Provider Information for 1073163804
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CHAD GLEN STEWART
Sex: Male
NPI: 1073163804
Last Updated: 2020-08-06
Certification Date: 2020-08-06
Certification Date: 2020-08-06
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1073163804 | ||||||||
| Enumeration Date | 2019-09-13 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 530 13TH AVE HAVRE, MT 59501-4247 United States Phone: 406-301-3463 | Fax: | ||||||||
| Primary Practice Address | 55 BASIN CREEK RD BUTTE, MT 59701-9704 United States Phone: 406-497-7907 | Fax: | ||||||||
| Secondary Practice Address(es) | 410 MAIN STREET EAST | ||||||||
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