Healthcare Provider Details

I. General information

NPI: 1659408029
Provider Name (Legal Business Name): LEWIS & MCCORRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 03/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3863 LAKE MICHIGAN DR NW
GRAND RAPIDS MI
49534-4520
US

IV. Provider business mailing address

3863 LAKE MICHIGAN DR NW
GRAND RAPIDS MI
49534-4520
US

V. Phone/Fax

Practice location:
  • Phone: 616-453-2429
  • Fax: 616-453-8340
Mailing address:
  • Phone: 616-453-2429
  • Fax: 616-453-8340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LEONARD A LEWIS JR.
Title or Position: MEMBER
Credential: DO
Phone: 616-453-2429