MEDICARE: DR. LEWIS EASTLICK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0105X	Surgery of the Hand (Surgery) Physician	3871974	ID
2	2086S0105X	Surgery of the Hand (Surgery) Physician	ME0055261	FL

General Provider Information

NPI Number	:	1013034925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEWIS EASTLICK M.D.

Provider Business Mailing Address
First Line	:	4100 NW 3RD CT STE 200
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33317-2837
Country	:	US
Telephone Number	:	954-797-7982
Fax Number	:

Provider Business Practice Location Address
First Line	:	4100 NW 3RD CT
Second Line	:	SUITE 200
City	:	PLANTATION
State	:	FL
Zip	:	33317-2813
Country	:	US
Telephone Number	:	954-797-7982
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	01/12/2026

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Directions to “ DR. LEWIS EASTLICK M.D.” Practice Location

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