Provider Demographics
NPI:1770618217
Name:RANDY LEW, DPM, PA
Entity type:Organization
Organization Name:RANDY LEW, DPM, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:LEW
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:817-615-8110
Mailing Address - Street 1:11807 SOUTH FWY
Mailing Address - Street 2:SUITE 361
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-7005
Mailing Address - Country:US
Mailing Address - Phone:817-615-8110
Mailing Address - Fax:817-615-8099
Practice Address - Street 1:11807 SOUTH FWY
Practice Address - Street 2:SUITE 361
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7005
Practice Address - Country:US
Practice Address - Phone:817-615-8110
Practice Address - Fax:817-615-8099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1495213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU80962Medicare UPIN
TX5099770001Medicare NSC
TX00162XMedicare ID - Type Unspecified