Healthcare Provider Details

I. General information

NPI: 1902929508
Provider Name (Legal Business Name): LEWIS ALBERT ANDRES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8595 E BELL RD STE 103
SCOTTSDALE AZ
85260-1306
US

IV. Provider business mailing address

PO BOX 15040
SCOTTSDALE AZ
85267-5040
US

V. Phone/Fax

Practice location:
  • Phone: 480-275-7800
  • Fax: 480-758-4587
Mailing address:
  • Phone: 480-275-7800
  • Fax: 602-331-5886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number40126
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number4301080203
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: