=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336038751
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ARTHUR L LEWIS JR.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/01/2025
-----------------------------------------------------
Last Update Date | 07/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1953 UNION AVE APT 3B
-----------------------------------------------------
City | BENTON HARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49022-6257
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-287-9933
-----------------------------------------------------
Fax | 269-287-9933
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1953 UNION AVE APT 3B AJLEONNI6@GMAIL.COM
-----------------------------------------------------
City | BENTON HARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49022
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-392-3555
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------