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General NPI Number Information
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NPI Number | 1306900386
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Entity Type | Organization
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Legal Business Name | EDMUND J LEWIS
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Dates
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Enumeration Date | 12/21/2006
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Last Update Date | 12/30/2021
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Provider Practice Location Address
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Address Line | 1426 W WASHINGTON BLVD
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City | CHICAGO
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State | IL
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Zip | 60607-1821
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Country | US
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Telephone | 312-829-1424
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Fax | 312-850-8431
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Provider Business Mailing Address
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Address Line | PO BOX 72354
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City | CLEVELAND
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State | OH
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Zip | 44192-0002
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Country | US
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Telephone | 312-829-1424
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Fax | 312-850-8431
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. SAMUEL NEAL SALTZBERG
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Credential | DR
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Telephone | 312-829-1424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 036082043
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License Number State | IL
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