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General NPI Number Information
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NPI Number | 1659675031
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Entity Type | Organization
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Legal Business Name | BARRY K LEWIS DO PLC
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Dates
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Enumeration Date | 12/29/2010
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Last Update Date | 12/29/2010
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Provider Practice Location Address
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Address Line | 37799 PROFESSIONAL CENTER DR SUITE 105
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City | LIVONIA
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State | MI
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Zip | 48154-1153
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Country | US
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Telephone | 734-462-0340
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 252798
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48325-2798
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Country | US
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Telephone | 734-462-0340
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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. BARRY LEWIS
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Credential | MD
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Telephone | 248-320-1997
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 5101007077
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License Number State | MI
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