Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2082S0105X | Plastic Hand Surgeon | IL |
NPI | 1780729269 |
---|---|
Provider Name | Dr. Nolan S Lewis |
First Address | Melrose Park, IL 60160-1422 |
Second Address | Melrose Park, IL 60160-1422 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2007 |
Last Update Date | 08/07/2007 |