Healthcare Provider Details

I. General information

NPI: 1760994529
Provider Name (Legal Business Name): MR. MICHAEL LEWIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2017
Last Update Date: 11/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 MAPLE CT
DAGSBORO DE
19939-9750
US

IV. Provider business mailing address

501 MAPLE CT
DAGSBORO DE
19939-9750
US

V. Phone/Fax

Practice location:
  • Phone: 302-519-2674
  • Fax:
Mailing address:
  • Phone: 302-519-2674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number17-60434-39-003
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: