Healthcare Provider Details

I. General information

NPI: 1407241631
Provider Name (Legal Business Name): CAITLIN LEWIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2015
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 TRANSPORTATION BLVD
GARFIELD HEIGHTS OH
44125-5371
US

IV. Provider business mailing address

9500 EUCLID AVE
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 877-440-8326
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number35.131301
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: