MEDICARE: MS. KAREN E LEWIS M.S.

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	170300000X	Genetic Counselor (M.S.)		MI

General Provider Information

NPI Number	:	1164411054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KAREN E LEWIS M.S.

Provider Business Mailing Address
First Line	:	4661 WINDCLIFF DR NE
Second Line	:
City	:	ROCKFORD
State	:	MI
Zip	:	49341-9069
Country	:	US
Telephone Number	:	616-863-0844
Fax Number	:

Provider Business Practice Location Address
First Line	:	4661 WINDCLIFF DR NE
Second Line	:
City	:	ROCKFORD
State	:	MI
Zip	:	49341-9069
Country	:	US
Telephone Number	:	616-863-0844
Fax Number	:

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

Provider Enumeration Date	:	10/14/2005
Last Update Date	:	07/08/2007

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