Provider Demographics
NPI:1114298387
Name:LEWIN, CRAIG EDWARD (AT,C)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:EDWARD
Last Name:LEWIN
Suffix:
Gender:M
Credentials:AT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 E 73RD AVE
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-4849
Mailing Address - Country:US
Mailing Address - Phone:219-947-2408
Mailing Address - Fax:
Practice Address - Street 1:2601 E 73RD AVE
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-4849
Practice Address - Country:US
Practice Address - Phone:219-947-2408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36001448A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer