Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 213000080 | |
N | 222Z00000X | Podiatrist | 213000080 | |
Y | 224P00000X | Prosthetist | 211000091 |
NPI | 1083376982 |
---|---|
Provider Name | Michael Allen Lewis |
First Address | Spring Valley, IL 61362-1860 |
Second Address | Spring Valley, IL 61362-1860 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2021 |
Last Update Date | 07/10/2021 |