Provider Demographics
NPI:1215223847
Name:EWEST, MICHELLE M (DO)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:EWEST
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 HICKMAN
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314
Mailing Address - Country:US
Mailing Address - Phone:515-282-2700
Mailing Address - Fax:515-282-2733
Practice Address - Street 1:4055 WESTOWN PKWY
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1033
Practice Address - Country:US
Practice Address - Phone:515-224-3399
Practice Address - Fax:515-241-3290
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA4446208000000X, 2080P0006X
IA044462080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1215223847Medicaid
IA175150177OtherMEDICARE