Healthcare Provider Details

I. General information

NPI: 1275524878
Provider Name (Legal Business Name): CHARLES W NEWTON III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 11/30/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 CHERRY ST SE
GRAND RAPIDS MI
49503-4601
US

IV. Provider business mailing address

555 MIDTOWNE STREET NE SUITE 400
GRAND RAPIDS MI
49503-5731
US

V. Phone/Fax

Practice location:
  • Phone: 616-774-7005
  • Fax: 616-774-0516
Mailing address:
  • Phone: 616-588-1200
  • Fax: 616-588-1250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number4301028291
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: