MEDICARE: CODY NEWLAND MD

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	208D00000X	General Practice Physician	0101272940	VA

General Provider Information

NPI Number	:	1770113821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CODY NEWLAND MD

Provider Business Mailing Address
First Line	:	6071 W OUTER DR
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48235-2624
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6071 W OUTER DR
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48235-2624
Country	:	US
Telephone Number	:	810-834-7405
Fax Number	:

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

Provider Enumeration Date	:	01/16/2020
Last Update Date	:	12/03/2025

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Directions to “ CODY NEWLAND MD” Practice Location

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