Healthcare Provider Details

I. General information

NPI: 1457323750
Provider Name (Legal Business Name): GEORGE LEW MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 04/19/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 S 1ST AVE LOYOLA UNIVERSITY MEDICAL CENTER, DEPT OF SURGERY
MAYWOOD IL
60153-3328
US

IV. Provider business mailing address

2160 S 1ST AVE LOYOLA UNIVERSITY MEDICAL CENTER, DEPT OF SURGERY
MAYWOOD IL
60153-3328
US

V. Phone/Fax

Practice location:
  • Phone: 708-327-2549
  • Fax: 708-327-2548
Mailing address:
  • Phone: 708-327-2549
  • Fax: 708-327-2548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number36104104
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number36104104
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: