Provider Demographics
NPI:1710952601
Name:LEWIN, STEVEN (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:LEWIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3775 ORCHARD LAKE RD APT 103
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48324-1600
Mailing Address - Country:US
Mailing Address - Phone:248-408-9023
Mailing Address - Fax:248-681-9187
Practice Address - Street 1:3775 ORCHARD LAKE RD APT 103
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48324-1600
Practice Address - Country:US
Practice Address - Phone:248-408-9023
Practice Address - Fax:248-681-9187
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010065422085R0202X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4794925Medicaid
IL036074312OtherIL MEDICAL LICENSE
MIF37432151Medicare ID - Type Unspecified
IL036074312OtherIL MEDICAL LICENSE