MEDICARE: PHILLIP ANDREW 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
1	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1801983960	OTHER	CA	ICM

General Provider Information

NPI Number	:	1972660215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILLIP ANDREW LEWIS

Provider Business Mailing Address
First Line	:	967 60TH ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94608-2301
Country	:	US
Telephone Number	:	510-553-8500
Fax Number	:	510-553-8550

Provider Business Practice Location Address
First Line	:	7200 BANCROFT AVE
Second Line	:	EASTMONT TOWN CENTER BLDG. B SUITE 133
City	:	OAKLAND
State	:	CA
Zip	:	94605-2403
Country	:	US
Telephone Number	:	510-553-8500
Fax Number	:	510-553-8550

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

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	07/08/2007

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Directions to “ PHILLIP ANDREW LEWIS ” Practice Location

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