Healthcare Provider Details

I. General information

NPI: 1588852909
Provider Name (Legal Business Name): JAMES E LEWANDOWSKI DPM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 10/08/2012
Certification Date:
Deactivation Date: 11/09/2007
Reactivation Date: 01/02/2008

III. Provider practice location address

820 W DIVISION ST
GRAND ISLAND NE
68801-6542
US

IV. Provider business mailing address

820 W DIVISION ST
GRAND ISLAND NE
68801-6542
US

V. Phone/Fax

Practice location:
  • Phone: 308-381-7262
  • Fax: 308-381-4672
Mailing address:
  • Phone: 308-381-7262
  • Fax: 308-381-4672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number230
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number230
License Number StateNE

VIII. Authorized Official

Name: JAMES E LEWANDOWSKI
Title or Position: PHYSICIAN OWNER
Credential: DPM
Phone: 308-381-7262