Healthcare Provider Details

I. General information

NPI: 1336185339
Provider Name (Legal Business Name): EWA B BAK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EWA BAK LEWIS

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29525 CHAGRIN BLVD STE 120
BEACHWOOD OH
44122-4601
US

IV. Provider business mailing address

29525 CHAGRIN BLVD STE 120
BEACHWOOD OH
44122-4601
US

V. Phone/Fax

Practice location:
  • Phone: 440-652-8250
  • Fax: 440-560-8531
Mailing address:
  • Phone: 440-652-8250
  • Fax: 440-560-8531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.120478
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: