MEDICARE: DEVON NEWSOM DO

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207Q00000X	Family Medicine Physician	5101028536	MI

General Provider Information

NPI Number	:	1407590003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEVON NEWSOM DO

Provider Business Mailing Address
First Line	:	24 FRANK LLOYD WRIGHT DR STE J2000
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48105-9484
Country	:	US
Telephone Number	:	734-747-6766
Fax Number	:

Provider Business Practice Location Address
First Line	:	5505 S OLD US 23 STE 100
Second Line	:
City	:	BRIGHTON
State	:	MI
Zip	:	48116-7524
Country	:	US
Telephone Number	:	810-494-6885
Fax Number	:	810-494-6839

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

Provider Enumeration Date	:	04/21/2022
Last Update Date	:	06/26/2025

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Directions to “ DEVON NEWSOM DO” Practice Location

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