MEDICARE: MR. PHILLIP E LEWELLEN PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	551	TN
2	363AM0700X	Medical Physician Assistant	551	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4071394	OTHER	TN	BCBS

General Provider Information

NPI Number	:	1134110356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PHILLIP E LEWELLEN PA

Provider Business Mailing Address
First Line	:	2011 MURPHY AVE
Second Line	:	SUITE 408
City	:	NASHVILLE
State	:	TN
Zip	:	37203-2023
Country	:	US
Telephone Number	:	615-327-1515
Fax Number	:	615-352-1428

Provider Business Practice Location Address
First Line	:	1995 E OAKLAND PARK BLVD
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33306-1147
Country	:	US
Telephone Number	:	954-791-6146
Fax Number	:	954-337-2733

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2005
Last Update Date	:	03/13/2019

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Directions to “ MR. PHILLIP E LEWELLEN PA” Practice Location

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