Provider Demographics
NPI:1235384801
Name:JOHNNIE LEWIS D.P.M P.C
Entity Type:Organization
Organization Name:JOHNNIE LEWIS D.P.M P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHNNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:312-674-1191
Mailing Address - Street 1:2850 S WABASH AVE
Mailing Address - Street 2:STE 206
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2955
Mailing Address - Country:US
Mailing Address - Phone:312-674-1191
Mailing Address - Fax:312-674-1192
Practice Address - Street 1:2850 S WABASH AVE
Practice Address - Street 2:STE 206
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2955
Practice Address - Country:US
Practice Address - Phone:312-674-1191
Practice Address - Fax:312-674-1192
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHNNIE LEWIS D.P.M. P.C
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-24
Last Update Date:2011-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004605213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty