MEDICARE: DR. JOHNNIE LEWIS DPM

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	213E00000X	Podiatrist	016004605	IL

General Provider Information

NPI Number	:	1013998194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHNNIE LEWIS DPM

Provider Business Mailing Address
First Line	:	2850 S WABASH AVE
Second Line	:	STE 206
City	:	CHICAGO
State	:	IL
Zip	:	60616-2491
Country	:	US
Telephone Number	:	773-288-1191
Fax Number	:	773-288-5502

Provider Business Practice Location Address
First Line	:	2850 S WABASH AVE
Second Line	:	STE 206
City	:	CHICAGO
State	:	IL
Zip	:	60616-2491
Country	:	US
Telephone Number	:	312-674-1191
Fax Number	:	312-674-1192

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

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	12/31/2021

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