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General NPI Number Information
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NPI Number | 1710151261
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Entity Type | Organization
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Legal Business Name | NOLAN S LEWIS MD SC
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Dates
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Enumeration Date | 04/16/2008
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Last Update Date | 04/16/2008
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Provider Practice Location Address
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Address Line | 1440 W NORTH AVE SUITE 201
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City | MELROSE PARK
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State | IL
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Zip | 60160-1425
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Country | US
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Telephone | 708-343-4280
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Fax | 408-343-4287
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Provider Business Mailing Address
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Address Line | 1440 W NORTH AVE SUITE 201
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City | MELROSE PARK
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State | IL
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Zip | 60160-1425
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Country | US
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Telephone | 708-343-4280
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Fax | 408-343-4287
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Authorized Official
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Title or Position | PRESIDENT
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Name | NOLAN S LEWIS
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Credential | MD
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Telephone | 708-343-4280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2082S0105X
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Taxonomy Name | Surgery of the Hand (Plastic Surgery) Physician
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License Number |
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License Number State | IL
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