Individual
MRS. DORALIZ STEWART
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
200 JEFFERSON AVE SE, GRAND RAPIDS, MI 49503-4502
(800) 968-6866
Mailing address
PO BOX Q, GRAND RAPIDS, MI 49501-4917
(800) 968-6866
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
4301089463
MI
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
4301089463
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5208263
—
MI
01
—
DH089463
BCBS
MI
01
—
P00443249
RAILROAD MEDICARE
—
Enumeration date
05/18/2007
Last updated
01/17/2023
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