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NPI Code Detail

MEDICARE: EDMUND J LEWIS

MEDICARE: EDMUND J LEWIS
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
1174400000XSpecialist036082043IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
101615381OTHERILBLUECROSS ID #
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3390002208RROTHERILRAILROAD MC ID#

General Provider Information

NPI Number : 1306900386
Entity Type Code : Organization
Provider Name (Legal Business Name) : EDMUND J LEWIS
Provider Business Mailing Address
First Line : PO BOX 72354
Second Line :
City : CLEVELAND
State : OH
Zip : 44192-0002
Country : US
Telephone Number : 312-829-1424
Fax Number : 312-850-8431
Provider Business Practice Location Address
First Line : 1426 W WASHINGTON BLVD
Second Line :
City : CHICAGO
State : IL
Zip : 60607-1821
Country : US
Telephone Number : 312-829-1424
Fax Number : 312-850-8431
Authorized Official
Title or Position : DOCTOR
Name : DR. SAMUEL NEAL SALTZBERG
Credential : DR
Telephone Number : 312-829-1424
Provider Enumeration Date : 12/21/2006
Last Update Date : 12/30/2021

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