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General NPI Number Information
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NPI Number | 1881613974
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Entity Type | Individual
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Provider Name | LEWIS M VICHINSKY DPM
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Gender | Male
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 11/19/2012
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Provider Practice Location Address
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Address Line | 245 STOCKSDALE DR
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City | MARYSVILLE
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State | OH
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Zip | 43040-1563
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Country | US
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Telephone | 937-642-9936
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Fax | 937-642-5537
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Provider Business Mailing Address
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Address Line | 245 STOCKSDALE DR
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City | MARYSVILLE
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State | OH
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Zip | 43040-1563
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Country | US
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Telephone | 937-642-9936
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Fax | 937-642-5537
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 36001774V
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | DPMPDD14R
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License Number State | LA
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