Healthcare Provider Details

I. General information

NPI: 1326967555
Provider Name (Legal Business Name): MICHAEL CHRISTOPHER LEWIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7127 AMBASSADOR RD
BALTIMORE MD
21244-2708
US

IV. Provider business mailing address

7127 AMBASSADOR RD
BALTIMORE MD
21244-2708
US

V. Phone/Fax

Practice location:
  • Phone: 312-376-1327
  • Fax:
Mailing address:
  • Phone: 312-376-1327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: