Provider Demographics
NPI:1013034925
Name:EASTLICK, LEWIS (MD)
Entity Type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:
Last Name:EASTLICK
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 1:4100 NW 3RD CT
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2813
Mailing Address - Country:US
Mailing Address - Phone:954-797-7982
Mailing Address - Fax:
Practice Address - Street 1:4100 NW 3RD CT
Practice Address - Street 2:SUITE 200
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2813
Practice Address - Country:US
Practice Address - Phone:954-797-7982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2009-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00552612086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF02375Medicare UPIN