Healthcare Provider Details

I. General information

NPI: 1114033453
Provider Name (Legal Business Name): MICHAEL NEWAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

1075 9TH AVE N
ST 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 TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME0081503
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: