Healthcare Provider Details

I. General information

NPI: 1720406523
Provider Name (Legal Business Name): MICHAEL CHIGOZIRI LEWIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2014
Last Update Date: 08/18/2026
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 PENN AVE STE 2464
PITTSBURGH PA
15224-1334
US

IV. Provider business mailing address

4401 PENN AVE STE 2464
PITTSBURGH PA
15224-1334
US

V. Phone/Fax

Practice location:
  • Phone: 412-647-0104
  • Fax:
Mailing address:
  • Phone: 412-861-8862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberMD478932
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4351029739
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: