MEDICARE: EAST BAY RHEUMATOLOGY MEDICAL GROUP, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	G38264	CA

General Provider Information

NPI Number	:	1891930673
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST BAY RHEUMATOLOGY MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	13851 E 14TH ST STE 301
Second Line	:
City	:	SAN LEANDRO
State	:	CA
Zip	:	94578-2630
Country	:	US
Telephone Number	:	510-357-1303
Fax Number	:	510-357-5463

Provider Business Practice Location Address
First Line	:	13851 E 14TH ST STE 301
Second Line	:
City	:	SAN LEANDRO
State	:	CA
Zip	:	94578-2630
Country	:	US
Telephone Number	:	510-357-1303
Fax Number	:	510-357-5463

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. CLARK MICHAEL NEUWELT
Credential	:	M.D.
Telephone Number	:	510-357-1303

Provider Enumeration Date	:	12/09/2008
Last Update Date	:	02/12/2014

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