MEDICARE: MICHELLE RENEE LEWIS LPN

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	164W00000X	Licensed Practical Nurse	4703076916	MI

General Provider Information

NPI Number	:	1750676185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE RENEE LEWIS LPN

Provider Business Mailing Address
First Line	:	13539 SANTA ROSA DR
Second Line	:	SUITE 343
City	:	DETROIT
State	:	MI
Zip	:	48238-2533
Country	:	US
Telephone Number	:	248-434-7426
Fax Number	:

Provider Business Practice Location Address
First Line	:	13539 SANTA ROSA DR
Second Line	:	SUITE 343
City	:	DETROIT
State	:	MI
Zip	:	48238-2533
Country	:	US
Telephone Number	:	248-434-7426
Fax Number	:

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

Provider Enumeration Date	:	06/14/2011
Last Update Date	:	03/21/2016

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Directions to “ MICHELLE RENEE LEWIS LPN” Practice Location

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