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NPI Code Detail

MEDICARE: EDMUND J LEWIS M D & ASSOCIATES

MEDICARE: EDMUND J LEWIS M D & ASSOCIATES
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
1207RN0300XNephrology Physician36045051IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11615381OTHERILBCBS P PROVIDER NUMBER

General Provider Information

NPI Number : 1588676944
Entity Type Code : Organization
Provider Name (Legal Business Name) : EDMUND J LEWIS M D & ASSOCIATES
Provider Business Mailing Address
First Line : PO BOX 72362
Second Line :
City : CLEVELAND
State : OH
Zip : 44192-0002
Country : US
Telephone Number : 331-216-1171
Fax Number :
Provider Business Practice Location Address
First Line : 104 S ASHLAND AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60607-2402
Country : US
Telephone Number : 312-850-8434
Fax Number : 312-829-3887
Authorized Official
Title or Position : PRESIDENT
Name : DR. MANISH TANNA
Credential : MD
Telephone Number : 630-573-5000
Provider Enumeration Date : 08/13/2006
Last Update Date : 02/04/2026

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Directions to “EDMUND J LEWIS M D & ASSOCIATES ” Practice Location

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