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General NPI Number Information
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NPI Number | 1952691271
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Entity Type | Organization
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Legal Business Name | LEWISVILLE INTERNAL MEDICINE ASSOCIATES PLLC
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Dates
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Enumeration Date | 04/08/2011
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Last Update Date | 04/08/2011
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Provider Practice Location Address
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Address Line | 2800 SHORELINE WAY
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City | LEWISVILLE
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State | TX
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Zip | 75056-4162
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Country | US
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Telephone | 860-919-9636
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 851323
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City | MESQUITE
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State | TX
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Zip | 75185-1323
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Country | US
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Telephone | 972-216-9511
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Fax | 972-216-9580
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Authorized Official
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Title or Position | PRESIDENT
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Name | SAJI JOHN
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Credential | M.D.
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Telephone | 860-919-9636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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