Provider Demographics
NPI:1689630154
Name:LEWANDOWSKI, MOLLY J (MD)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:J
Last Name:LEWANDOWSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7201 E 147TH ST
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:MO
Mailing Address - Zip Code:64030-4204
Mailing Address - Country:US
Mailing Address - Phone:816-348-2260
Mailing Address - Fax:913-495-3751
Practice Address - Street 1:7201 E 147TH ST
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:MO
Practice Address - Zip Code:64030-4204
Practice Address - Country:US
Practice Address - Phone:816-348-2260
Practice Address - Fax:913-495-3375
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-36982207R00000X
MOR2J53207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOF36419Medicare UPIN