=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245358993
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHEN M LEWINSON DPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2007
-----------------------------------------------------
Last Update Date | 07/07/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9001 WILSHIRE BLVD SUITE # 308
-----------------------------------------------------
City | BEVERLY HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90211-1838
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-313-5027
-----------------------------------------------------
Fax | 815-346-5796
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 5322
-----------------------------------------------------
City | PLAYA DEL REY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90296-5322
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-313-5027
-----------------------------------------------------
Fax | 815-346-5796
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | E3757
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------