Provider Demographics
NPI:1548253206
Name:NEWCOMB, MICHAEL PATRICK (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PATRICK
Last Name:NEWCOMB
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 1:29455 N CAVE CREEK RD
Mailing Address - Street 2:SUITE 118-605
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-3245
Mailing Address - Country:US
Mailing Address - Phone:602-996-5595
Mailing Address - Fax:602-996-5610
Practice Address - Street 1:29455 N CAVE CREEK RD
Practice Address - Street 2:SUITE 118-605
Practice Address - City:CAVE CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85331-3245
Practice Address - Country:US
Practice Address - Phone:602-996-5595
Practice Address - Fax:602-996-5610
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21132207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ148305Medicaid
AZ148305Medicaid
AZ68170Medicare ID - Type Unspecified