Provider Demographics
NPI:1245618842
Name:LEWIN, MATTHEW WILLIAM ELWOOD (DPM)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:WILLIAM ELWOOD
Last Name:LEWIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1133 SW BAKER ST, SUITE A
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128
Mailing Address - Country:US
Mailing Address - Phone:734-241-0200
Mailing Address - Fax:734-241-1961
Practice Address - Street 1:1133 SW BAKER ST, SUITE A
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128
Practice Address - Country:US
Practice Address - Phone:503-472-3341
Practice Address - Fax:503-472-7916
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-14
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIML002561213ES0103X
ORDP215978213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery