Provider Demographics
NPI:1184840134
Name:DR.IRVING M. LEWIS, PODIATRIST, INC.
Entity Type:Organization
Organization Name:DR.IRVING M. LEWIS, PODIATRIST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IRVING
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:216-765-1151
Mailing Address - Street 1:3609 PARK EAST DR
Mailing Address - Street 2:#414 NORTH
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4331
Mailing Address - Country:US
Mailing Address - Phone:216-765-1151
Mailing Address - Fax:216-765-0389
Practice Address - Street 1:3609 PARK EAST DR
Practice Address - Street 2:#414 NORTH
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4331
Practice Address - Country:US
Practice Address - Phone:216-765-1151
Practice Address - Fax:216-765-0389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36001287L213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000230211OtherANTHEM
OH000000230211OtherANTHEM
OHDR9326711Medicare ID - Type Unspecified