Provider Demographics
NPI:1619985090
Name:LEW, MICHAEL MINYOUNG (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:MINYOUNG
Last Name:LEW
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 1:24723 DETROIT RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-2526
Mailing Address - Country:US
Mailing Address - Phone:440-892-1440
Mailing Address - Fax:440-892-4709
Practice Address - Street 1:24723 DETROIT RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-2526
Practice Address - Country:US
Practice Address - Phone:440-892-1440
Practice Address - Fax:440-892-4709
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-4972-L207X00000X, 207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0171371Medicaid
OHLE0790052Medicare PIN
OHF77487Medicare UPIN
OHLE0790051Medicare ID - Type Unspecified