MEDICARE: DR. MARVIN JAY LEWIS AU.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	231H00000X	Audiologist	A00841	OH

General Provider Information

NPI Number	:	1770697591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARVIN JAY LEWIS AU.D.

Provider Business Mailing Address
First Line	:	4807 ROCKSIDE RD
Second Line	:	#400
City	:	INDEPENDENCE
State	:	OH
Zip	:	44131-2192
Country	:	US
Telephone Number	:	216-642-8228
Fax Number	:	216-642-8229

Provider Business Practice Location Address
First Line	:	4807 ROCKSIDE RD
Second Line	:	#400
City	:	INDEPENDENCE
State	:	OH
Zip	:	44131-2192
Country	:	US
Telephone Number	:	216-642-8228
Fax Number	:	216-642-8229

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

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	07/08/2007

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