Provider Demographics
NPI:1598786790
Name:NEUWELT, C. MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:C. MICHAEL
Middle Name:
Last Name:NEUWELT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13851 E 14TH ST
Mailing Address - Street 2:STE 301
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-2631
Mailing Address - Country:US
Mailing Address - Phone:510-357-1303
Mailing Address - Fax:510-357-5463
Practice Address - Street 1:13851 E 14TH ST
Practice Address - Street 2:STE 301
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-2631
Practice Address - Country:US
Practice Address - Phone:510-357-1303
Practice Address - Fax:510-357-5463
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG38264207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G382640Medicare PIN
CAA47417Medicare UPIN