Provider Demographics
NPI:1528025277
Name:LEW, RANDY MICHAEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:MICHAEL
Last Name:LEW
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:RANDY
Other - Middle Name:MICHAEL
Other - Last Name:LEW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:11807 SOUTH FWY
Mailing Address - Street 2:STE. 361
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-7005
Mailing Address - Country:US
Mailing Address - Phone:817-615-8110
Mailing Address - Fax:817-615-8099
Practice Address - Street 1:11807 SOUTH FWY
Practice Address - Street 2:STE. 361
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7005
Practice Address - Country:US
Practice Address - Phone:817-615-8110
Practice Address - Fax:817-615-8099
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1495213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU80962Medicare UPIN