Healthcare Provider Details

I. General information

NPI: 1720249006
Provider Name (Legal Business Name): MICHAEL M NEWAN MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 9TH AVE N
SAINT PETERSBURG FL
33705-1255
US

IV. Provider business mailing address

1075 9TH AVE N
SAINT PETERSBURG FL
33705-1255
US

V. Phone/Fax

Practice location:
  • Phone: 727-895-5864
  • Fax: 727-896-9598
Mailing address:
  • Phone: 727-895-5864
  • Fax: 727-896-9598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberME81503
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME81503
License Number StateFL

VIII. Authorized Official

Name: MICHAEL M NEWAN
Title or Position: PRESIDENT
Credential: MD
Phone: 727-895-5864