Provider Demographics
NPI:1720084114
Name:MAWBY, MICHAEL L (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:MAWBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 728
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49685-0728
Mailing Address - Country:US
Mailing Address - Phone:231-935-0550
Mailing Address - Fax:231-935-0551
Practice Address - Street 1:1115 S UNION ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-3258
Practice Address - Country:US
Practice Address - Phone:231-935-0550
Practice Address - Fax:231-935-0551
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301051186207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1102802841OtherBC/BS OF MI
MI131101OtherUNITED HEALTH CARE
MI1720084114OtherMICHAEL L MAWBY MD
MI1102802841OtherBLUE CARE NETWORK
MI4324974Medicaid
MI660003547OtherTRICARE/CHAMPUS
MIF60038OtherPRIORITY
MI4324974Medicaid
MI0P24620001Medicare PIN