Individual
MR. MICHAEL CHARLES STEWART JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
159 TROUT AVENUE, GROTON, CT 06349
(224) 623-3289
Mailing address
159 TROUT AVENUE, GROTON, CT 06349
(224) 623-3289
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3933
MILITARY-INDEPENDENT DUTY CORPSMAN
CT
Enumeration date
04/19/2013
Last updated
04/19/2013
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