Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 036057677 | IL |
NPI | 1023098910 |
---|---|
Provider Name | Dr. Gregory A Lewis |
First Address | Joliet, IL 60431-9341 |
Second Address | Joliet, IL 60431-9341 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2006 |
Last Update Date | 23/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036057677 | (05) | IL |
D15076 | (02) | IL |