Healthcare Provider Details

I. General information

NPI: 1821017633
Provider Name (Legal Business Name): DOMINIC J LEWIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 04/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21000 NE 28TH AVE STE 104
AVENTURA FL
33180-1421
US

IV. Provider business mailing address

21000 NE 28TH AVE STE 104
AVENTURA FL
33180-1421
US

V. Phone/Fax

Practice location:
  • Phone: 305-937-1999
  • Fax:
Mailing address:
  • Phone: 305-937-1999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberME98975
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: