Healthcare Provider Details

I. General information

NPI: 1245265966
Provider Name (Legal Business Name): MICHAEL A NEWDOW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 09/22/2024
Certification Date: 09/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3534 E STATE HWY 20 STE 4
NICE CA
95464-8573
US

IV. Provider business mailing address

PO BOX 248
NICE CA
95464-0248
US

V. Phone/Fax

Practice location:
  • Phone: 707-721-4317
  • Fax:
Mailing address:
  • Phone: 916-201-6078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberG48913
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number108085
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number15151
License Number StateMS
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG48913
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberG48913
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG48913
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberG48913
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberG48913
License Number StateCA
# 9
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberG48913
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: