Provider Demographics
NPI:1114033453
Name:NEWAN, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:NEWAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 9TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-1255
Mailing Address - Country:US
Mailing Address - Phone:727-895-5864
Mailing Address - Fax:727-896-9598
Practice Address - Street 1:1075 9TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1255
Practice Address - Country:US
Practice Address - Phone:727-895-5864
Practice Address - Fax:727-896-9598
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0081503207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
290014717OtherRAILROAD MEDICARE
279351OtherAVMED
N188582OtherWELLCARE
FL261165100Medicaid
5918436OtherAETNA
N188582OtherHEALTHEASE
220817OtherAMERIGROUP
58895OtherBCBS
N188582OtherSTAYWELL
290014717OtherRAILROAD MEDICARE
5918436OtherAETNA