Healthcare Provider Details

I. General information

NPI: 1689618092
Provider Name (Legal Business Name): ARTHUR J LEWANDOWSKI
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26811 RYAN RD
WARREN MI
48091-4075
US

IV. Provider business mailing address

26811 RYAN RD
WARREN MI
48091-4075
US

V. Phone/Fax

Practice location:
  • Phone: 586-755-4433
  • Fax: 586-755-6655
Mailing address:
  • Phone: 586-755-4433
  • Fax: 586-755-6655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301003293
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: