MEDICARE: ROBERT NEWHOUSE M.D.

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	2084P0800X	Psychiatry Physician	3799728	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3799728	OTHER	MI	STATE OF MICHIGAN

General Provider Information

NPI Number	:	1366893091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT NEWHOUSE M.D.

Provider Business Mailing Address
First Line	:	3977 JEFFERSON RD
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-2168
Country	:	US
Telephone Number	:	231-218-9914
Fax Number	:	231-929-7092

Provider Business Practice Location Address
First Line	:	3977 JEFFERSON RD
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-2168
Country	:	US
Telephone Number	:	231-218-9914
Fax Number	:	231-929-7092

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2016
Last Update Date	:	06/23/2016

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