Provider Demographics
NPI:1588676944
Name:EDMUND J LEWIS MD & ASSOCIATES
Entity Type:Organization
Organization Name:EDMUND J LEWIS MD & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-829-1424
Mailing Address - Street 1:PO BOX 72354
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44192-0002
Mailing Address - Country:US
Mailing Address - Phone:312-850-8434
Mailing Address - Fax:312-829-3887
Practice Address - Street 1:1426 W WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-1821
Practice Address - Country:US
Practice Address - Phone:312-850-8434
Practice Address - Fax:312-829-3887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36045051174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA110042308OtherRAILROAD MEDICARE
IL1615381OtherBCBS P PROVIDER NUMBER
IL=========Medicaid
IL469280Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER