Healthcare Provider Details

I. General information

NPI: 1619919529
Provider Name (Legal Business Name): LEW A LITTLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2103 S MCCALL RD
ENGLEWOOD FL
34224-4541
US

IV. Provider business mailing address

2103 S MCCALL RD
ENGLEWOOD FL
34224-4541
US

V. Phone/Fax

Practice location:
  • Phone: 941-441-9007
  • Fax: 941-249-3119
Mailing address:
  • Phone: 941-249-3119
  • Fax: 941-249-3119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME100763
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License NumberME100763
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberME100763
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberME100763
License Number StateFL
# 6
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME100763
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberME100763
License Number StateFL
# 8
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License NumberME100763
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: