Healthcare Provider Details

I. General information

NPI: 1437596186
Provider Name (Legal Business Name): FRANKLIN E LEW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2013
Last Update Date: 09/03/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5995 SPRING CREEK RD
ROCKFORD IL
61114-6481
US

IV. Provider business mailing address

5995 SPRING CREEK RD
ROCKFORD IL
61114-6481
US

V. Phone/Fax

Practice location:
  • Phone: 815-977-4403
  • Fax: 815-977-4403
Mailing address:
  • Phone: 815-977-4403
  • Fax: 815-977-5796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number036153448
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: