Provider Demographics
NPI:1558479469
Name:LEWIS, RAJA EDMON (MD)
Entity Type:Individual
Prefix:
First Name:RAJA
Middle Name:EDMON
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3840 17 MILE RD
Mailing Address - Street 2:RAJA LEWIS
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-6831
Mailing Address - Country:US
Mailing Address - Phone:586-826-9625
Mailing Address - Fax:586-826-9622
Practice Address - Street 1:3840 17 MILE RD
Practice Address - Street 2:RAJA LEWIS
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-6831
Practice Address - Country:US
Practice Address - Phone:586-826-9625
Practice Address - Fax:586-826-9622
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI430107257207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4390307Medicaid
ON78570Medicare ID - Type Unspecified
MI4390307Medicaid
N88770001Medicare PIN