Healthcare Provider Details

I. General information

NPI: 1184186488
Provider Name (Legal Business Name): PAUL EUGENE LEWIS I
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2019
Last Update Date: 04/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W 6TH AVE
GARY IN
46402-1711
US

IV. Provider business mailing address

3363 S MANOR DR
LANSING IL
60438-3622
US

V. Phone/Fax

Practice location:
  • Phone: 219-885-4264
  • Fax:
Mailing address:
  • Phone: 773-430-9938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: