MEDICARE: NEWTON, FRANK & BLICKLEY, MD, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1326121351
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEWTON, FRANK & BLICKLEY, MD, PC

Provider Business Mailing Address
First Line	:	710 KENMOOR AVE SE
Second Line	:	SUITE 100
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-2379
Country	:	US
Telephone Number	:	616-957-1510
Fax Number	:	616-957-0687

Provider Business Practice Location Address
First Line	:	710 KENMOOR AVE SE
Second Line	:	SUITE 100
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-2379
Country	:	US
Telephone Number	:	616-957-1510
Fax Number	:	616-957-0687

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	KRISTEN A ANDERSON
Credential	:
Telephone Number	:	616-957-1510

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	08/22/2020

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