Provider Demographics
NPI:1679177620
Name:ROBERT D LEWIS MD LLC
Entity type:Organization
Organization Name:ROBERT D LEWIS MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-967-4224
Mailing Address - Street 1:4139 BOARDMAN CANFIELD RD STE B
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9034
Mailing Address - Country:US
Mailing Address - Phone:330-967-4224
Mailing Address - Fax:330-967-4226
Practice Address - Street 1:4139 BOARDMAN CANFIELD RD STE B
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-9034
Practice Address - Country:US
Practice Address - Phone:330-967-4224
Practice Address - Fax:330-967-4226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-30
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty