MEDICARE: ANDREW LEWANDOSKI D.O.

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	207RR0500X	Rheumatology Physician	5101022955	MI
2	207R00000X	Internal Medicine Physician	63429	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578806113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW LEWANDOSKI D.O.

Provider Business Mailing Address
First Line	:	6741 FULTON ST E
Second Line	:
City	:	ADA
State	:	MI
Zip	:	49301-9502
Country	:	US
Telephone Number	:	616-320-5330
Fax Number	:	616-320-5331

Provider Business Practice Location Address
First Line	:	6741 FULTON ST E
Second Line	:
City	:	ADA
State	:	MI
Zip	:	49301-9502
Country	:	US
Telephone Number	:	616-320-5330
Fax Number	:	616-320-5331

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

Provider Enumeration Date	:	04/02/2013
Last Update Date	:	04/13/2023

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