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General NPI Number Information
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NPI Number | 1912168907
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Entity Type | Individual
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Provider Name | MADELYN LEW MD
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Gender | Female
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Dates
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Enumeration Date | 06/23/2008
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Last Update Date | 09/03/2013
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Provider Practice Location Address
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Address Line | 1500 E MEDICAL CENTER DR 2ND FLOOR UNIVERSITY HOSPITAL RECP PATHOLOGY
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City | ANN ARBOR
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State | MI
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Zip | 48109-5000
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Country | US
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Telephone | 800-862-7284
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Fax | 734-615-2964
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Provider Business Mailing Address
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Address Line | 3621 S STATE ST 700 KMS PLACE
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City | ANN ARBOR
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State | MI
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Zip | 48108-1633
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Country | US
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Telephone | 734-936-2047
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Fax |
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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 | 207ZP0101X
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Taxonomy Name | Anatomic Pathology Physician
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License Number | 4301103616
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | L-236220
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 4301103616
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License Number State | MI
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