Provider Demographics
NPI:1790490969
Name:LEWIS, DANIEL LEVAR
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:LEVAR
Last Name:LEWIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:773 MARIE AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44314-3155
Mailing Address - Country:US
Mailing Address - Phone:330-564-3107
Mailing Address - Fax:
Practice Address - Street 1:773 MARIE AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44314-3155
Practice Address - Country:US
Practice Address - Phone:330-564-3107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRJ740286172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty