Provider Demographics
NPI:1063458404
Name:PRICE, MICHAEL NEWTON (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:NEWTON
Last Name:PRICE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:643 CAPE CORAL PKWY E
Mailing Address - Street 2:STE. D
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-8549
Mailing Address - Country:US
Mailing Address - Phone:239-542-3581
Mailing Address - Fax:239-542-4725
Practice Address - Street 1:643 CAPE CORAL PKWY E
Practice Address - Street 2:STE. D
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-8549
Practice Address - Country:US
Practice Address - Phone:239-542-3581
Practice Address - Fax:239-542-4725
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP00001617213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL029665100Medicaid
FL029665100Medicaid
FL87866XMedicare PIN
FL480023321Medicare PIN