Healthcare Provider Details

I. General information

NPI: 1962522250
Provider Name (Legal Business Name): GREGORY DAVID LEWEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 03/24/2021
Certification Date: 03/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20803 BISCAYNE BLVD SUITE 110
AVENTURA FL
33180-1429
US

IV. Provider business mailing address

20803 BISCAYNE BLVD SUITE 110
AVENTURA FL
33180-1429
US

V. Phone/Fax

Practice location:
  • Phone: 305-514-0631
  • Fax: 305-514-0641
Mailing address:
  • Phone: 305-514-0631
  • Fax: 305-514-0641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number063682
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberM8124
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME 108618
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License NumberME108618
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: