Healthcare Provider Details

I. General information

NPI: 1659375285
Provider Name (Legal Business Name): MITCHELL DEAN LEWIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7020 OVERSEAS HWY
MARATHON FL
33050-3140
US

IV. Provider business mailing address

7020 OVERSEAS HWY
MARATHON FL
33050-3140
US

V. Phone/Fax

Practice location:
  • Phone: 305-743-0304
  • Fax:
Mailing address:
  • Phone: 305-743-0304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME0065309
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: