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General NPI Number Information
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NPI Number | 1720084114
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Entity Type | Individual
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Provider Name | MICHAEL L MAWBY M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/22/2005
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Last Update Date | 03/04/2014
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Provider Practice Location Address
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Address Line | 1115 S UNION ST
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-3258
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Country | US
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Telephone | 231-935-0550
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Fax | 231-935-0551
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Provider Business Mailing Address
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Address Line | PO BOX 728
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City | TRAVERSE CITY
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State | MI
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Zip | 49685-0728
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Country | US
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Telephone | 231-935-0550
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Fax | 231-935-0551
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 4301051186
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License Number State | MI
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