=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558464008
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL A MCEWEN, M.D., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5730 US HIGHWAY 431
-----------------------------------------------------
City | ALBERTVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35950-0234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-878-9231
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5730 US HIGHWAY 431
-----------------------------------------------------
City | ALBERTVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35950-0234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-878-9231
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MICHAEL A MCEWEN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 256-492-7158
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 6989
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------