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General NPI Number Information
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NPI Number | 1588676944
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Entity Type | Organization
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Legal Business Name | EDMUND J LEWIS M D & ASSOCIATES
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Dates
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Enumeration Date | 08/13/2006
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Last Update Date | 02/04/2026
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Provider Practice Location Address
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Address Line | 104 S ASHLAND AVE
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City | CHICAGO
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State | IL
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Zip | 60607-2402
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Country | US
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Telephone | 312-850-8434
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Fax | 312-829-3887
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Provider Business Mailing Address
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Address Line | PO BOX 72362
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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 | 331-216-1171
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MANISH TANNA
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Credential | MD
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Telephone | 630-573-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 36045051
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License Number State | IL
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