Healthcare Provider Details

I. General information

NPI: 1699753459
Provider Name (Legal Business Name): MICHAEL EUWEMA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3625 UNIVERSITY BLVD S EMERGENCY DEPARTMENT
JACKSONVILLE FL
32216-4207
US

IV. Provider business mailing address

2392 WATERMILL DR
ORANGE PARK FL
32073-1638
US

V. Phone/Fax

Practice location:
  • Phone: 904-346-3606
  • Fax: 904-346-0113
Mailing address:
  • Phone: 904-779-9295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME0091658
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: