MEDICARE: DR. NOLAN S LEWIS MD

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	2082S0105X	Surgery of the Hand (Plastic Surgery) Physician		IL

General Provider Information

NPI Number	:	1780729269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NOLAN S LEWIS MD

Provider Business Mailing Address
First Line	:	1440 W NORTH AVE
Second Line	:	SUITE 201
City	:	MELROSE PARK
State	:	IL
Zip	:	60160-1422
Country	:	US
Telephone Number	:	708-343-4280
Fax Number	:	708-343-4287

Provider Business Practice Location Address
First Line	:	1440 W NORTH AVE
Second Line	:	SUITE 201
City	:	MELROSE PARK
State	:	IL
Zip	:	60160-1422
Country	:	US
Telephone Number	:	708-343-4280
Fax Number	:	708-343-4287

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

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	07/08/2007

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