Provider Demographics
NPI:1245265966
Name:NEWDOW, MICHAEL A (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:NEWDOW
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:PO BOX 248
Mailing Address - Street 2:
Mailing Address - City:NICE
Mailing Address - State:CA
Mailing Address - Zip Code:95464-0248
Mailing Address - Country:US
Mailing Address - Phone:916-201-6078
Mailing Address - Fax:
Practice Address - Street 1:3534 E STATE HWY 20 STE 4
Practice Address - Street 2:
Practice Address - City:NICE
Practice Address - State:CA
Practice Address - Zip Code:95464-8573
Practice Address - Country:US
Practice Address - Phone:707-721-4317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2024-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48913208000000X, 207RA0401X, 2083P0901X, 261QA1903X, 208D00000X, 208VP0014X, 207P00000X
MO108085207P00000X
MS15151207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B48086Medicare UPIN