MEDICARE: DR. ANGELA S LEW HSPP

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	103TC0700X	Clinical Psychologist	20041121A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	K46442	OTHER	IL	MEDICARE PTAN

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	:	1750350187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELA S LEW HSPP

Provider Business Mailing Address
First Line	:	8770 W BRYN MAWR AVE
Second Line	:	SUITE 1300
City	:	CHICAGO
State	:	IL
Zip	:	60631-3515
Country	:	US
Telephone Number	:	877-807-5120
Fax Number	:	708-460-4120

Provider Business Practice Location Address
First Line	:	8770 W BRYN MAWR AVE
Second Line	:	SUITE 1300
City	:	CHICAGO
State	:	IL
Zip	:	60631-3515
Country	:	US
Telephone Number	:	877-807-5120
Fax Number	:	708-460-4120

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

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	06/16/2009

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