Healthcare Provider Details

I. General information

NPI: 1578478988
Provider Name (Legal Business Name): LISA LEWIS-MICHALSKI
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N VAN DYKE RD
BAD AXE MI
48413-9174
US

IV. Provider business mailing address

901 N VAN DYKE RD
BAD AXE MI
48413-9174
US

V. Phone/Fax

Practice location:
  • Phone: 989-269-7958
  • Fax:
Mailing address:
  • Phone: 989-269-7958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: