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:MICHELLE
Other - Middle Name:M
Other - Last Name:MAKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:4055 WESTOWN PKWY
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1033
Mailing Address - Country:US
Mailing Address - Phone:515-224-3300
Mailing Address - Fax:515-241-4320
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:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA44462080P0006X, 208000000X
IA044462080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1215223847Medicaid
IA175150177OtherMEDICARE