Healthcare Provider Details

I. General information

NPI: 1013120294
Provider Name (Legal Business Name): AGA JULIA LEWELT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 02/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13535 NEMOURS PARKWAY NEMOURS CHILDRENS HOSPITAL
ORLANDO FL
32827-7402
US

IV. Provider business mailing address

10140 CENTURION PKWY N FL PROVIDER
JACKSONVILLE FL
32256-0532
US

V. Phone/Fax

Practice location:
  • Phone: 407-567-4000
  • Fax:
Mailing address:
  • Phone: 904-697-4127
  • Fax: 904-697-5102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberME119908
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License NumberD0065555
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License NumberME119908
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: