Provider Demographics
NPI:1871541292
Name:STEWART, KEVIN PHILLIP (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:PHILLIP
Last Name:STEWART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5981
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00823-5981
Mailing Address - Country:US
Mailing Address - Phone:340-773-2015
Mailing Address - Fax:340-719-9590
Practice Address - Street 1:4500 SION FARM
Practice Address - Street 2:ISLAND MEDICAL CENTER SUITE 19
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820-4493
Practice Address - Country:US
Practice Address - Phone:340-773-2015
Practice Address - Fax:340-719-9590
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY226054207W00000X
FLME102455207W00000X
VI1452207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI20989Medicare UPIN