MEDICARE: DR. JAMES S LEWERENZ D.O.

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	207Q00000X	Family Medicine Physician	5101013482	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	700H217350	OTHER	MI	BLUE SHIELD
2	G82387	OTHER	MI	HAP
3	131589	OTHER	MI	CARE-PREFERRED CHOICES
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	5631232	OTHER	MI	BCBS INDIVIDUAL

General Provider Information

NPI Number	:	1952385700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES S LEWERENZ D.O.

Provider Business Mailing Address
First Line	:	1467 E 12 MILE RD
Second Line	:
City	:	MADISON HEIGHTS
State	:	MI
Zip	:	48071-2653
Country	:	US
Telephone Number	:	248-548-3060
Fax Number	:	248-548-3078

Provider Business Practice Location Address
First Line	:	1467 E 12 MILE RD
Second Line	:
City	:	MADISON HEIGHTS
State	:	MI
Zip	:	48071-2653
Country	:	US
Telephone Number	:	248-548-3060
Fax Number	:	248-548-3078

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

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	02/16/2011

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