Provider Demographics
NPI:1902031073
Name:LEWIS, MICHAEL LOREN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LOREN
Last Name:LEWIS
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:PO BOX 5453
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-5453
Mailing Address - Country:US
Mailing Address - Phone:718-780-3272
Mailing Address - Fax:718-780-3079
Practice Address - Street 1:506 6 STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215
Practice Address - Country:US
Practice Address - Phone:718-780-3272
Practice Address - Fax:718-780-3079
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-19
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA107781174400000X
NY257204207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist