MEDICARE: DR. LEWIS EDWARD OKUN PH.D.

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	103TC0700X	Clinical Psychologist	6301002860	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	620N112940	OTHER	MI	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1265581458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEWIS EDWARD OKUN PH.D.

Provider Business Mailing Address
First Line	:	2301 S HURON PKWY STE 3A
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48104-5133
Country	:	US
Telephone Number	:	734-223-1248
Fax Number	:	888-403-0285

Provider Business Practice Location Address
First Line	:	2301 S HURON PKWY STE 3A
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48104-5133
Country	:	US
Telephone Number	:	734-223-1248
Fax Number	:	888-403-0285

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

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	09/08/2022

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