Healthcare Provider Details

I. General information

NPI: 1013968866
Provider Name (Legal Business Name): SEAN M LEW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 W WISCONSIN AVE
MILWAUKEE WI
53226-4874
US

IV. Provider business mailing address

9000 W WISCONSIN AVE
MILWAUKEE WI
53226-4874
US

V. Phone/Fax

Practice location:
  • Phone: 414-266-6435
  • Fax: 414-955-0131
Mailing address:
  • Phone: 414-266-6435
  • Fax: 414-955-0131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number47155
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: