Provider Demographics
NPI:1639150824
Name:LEWIS, MICHAEL T (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:T
Last Name:LEWIS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 LAKEVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:NC
Mailing Address - Zip Code:28398-9589
Mailing Address - Country:US
Mailing Address - Phone:910-293-3619
Mailing Address - Fax:
Practice Address - Street 1:600 S SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:ROSE HILL
Practice Address - State:NC
Practice Address - Zip Code:28458-4700
Practice Address - Country:US
Practice Address - Phone:910-289-3027
Practice Address - Fax:910-289-2894
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103247363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P81344Medicare UPIN