Provider Demographics
NPI:1659404812
Name:MARK J LEWIS MD PLC
Entity Type:Organization
Organization Name:MARK J LEWIS MD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-698-6727
Mailing Address - Street 1:15450 N TATUM BLVD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-4241
Mailing Address - Country:US
Mailing Address - Phone:888-698-6727
Mailing Address - Fax:
Practice Address - Street 1:15450 N TATUM BLVD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4241
Practice Address - Country:US
Practice Address - Phone:888-698-6727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0760272OtherBCBS
AZ2Z6843OtherHEALTHNET
AZ7551697OtherAETNA
AZI15084Medicare UPIN
AZ7551697OtherAETNA