Provider Demographics
NPI:1326054131
Name:CHAIKIN, LEWIS B (MD)
Entity Type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:B
Last Name:CHAIKIN
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 1:4048 EVANS AVE STE 306
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9390
Mailing Address - Country:US
Mailing Address - Phone:239-433-3323
Mailing Address - Fax:
Practice Address - Street 1:4048 EVANS AVE STE 306
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-9390
Practice Address - Country:US
Practice Address - Phone:239-433-3323
Practice Address - Fax:239-433-7757
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME35345208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL36352Medicare ID - Type Unspecified