Healthcare Provider Details

I. General information

NPI: 1255652319
Provider Name (Legal Business Name): LEWIS HELLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2010
Last Update Date: 06/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11120 N TATUM BLVD SUITE 101
PHOENIX AZ
85028-1628
US

IV. Provider business mailing address

11120 N TATUM BLVD SUITE 101
PHOENIX AZ
85028-1628
US

V. Phone/Fax

Practice location:
  • Phone: 602-502-4000
  • Fax:
Mailing address:
  • Phone: 602-502-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number14873
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: