Provider Demographics
NPI:1831179100
Name:LEWIS, BARRY K (DO)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:K
Last Name:LEWIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:37799 PROFESSIONAL CENTER DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-1153
Mailing Address - Country:US
Mailing Address - Phone:734-464-3251
Mailing Address - Fax:734-464-3368
Practice Address - Street 1:37799 PROFESSIONAL CENTER DR
Practice Address - Street 2:SUITE 105
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-1153
Practice Address - Country:US
Practice Address - Phone:734-464-3251
Practice Address - Fax:734-464-3368
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007077207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2843691-11Medicaid
MI2843691-11Medicaid