Provider Demographics
NPI:1649241811
Name:LEWIS, PAUL C (DO)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:C
Last Name:LEWIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6815 DIXIE HWY STE 1
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-2092
Mailing Address - Country:US
Mailing Address - Phone:248-384-8350
Mailing Address - Fax:248-384-8351
Practice Address - Street 1:6815 DIXIE HWY STE 1
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2092
Practice Address - Country:US
Practice Address - Phone:248-384-8350
Practice Address - Fax:248-384-8351
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011425207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4431722Medicaid
MIG15180Medicare UPIN