Healthcare Provider Details

I. General information

NPI: 1558227306
Provider Name (Legal Business Name): MICHAEL LEWIS JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/24/2025
Last Update Date: 12/24/2025
Certification Date: 12/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4017 MINNESOTA AVE NE
WASHINGTON DC
20019-3541
US

IV. Provider business mailing address

5203 LEESBURG PIKE APT 1417
FALLS CHURCH VA
22041-3414
US

V. Phone/Fax

Practice location:
  • Phone: 202-388-9202
  • Fax: 202-388-4339
Mailing address:
  • Phone: 214-542-7670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: