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Individual

DR. ELENA JEAN LEWIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Taxonomy

Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
Primary
EL085524
MI
208000000X
Pediatrics Physician
4301085524
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1194928994
MI
01
700C910950
BCBSM
MI
Enumeration date
06/08/2007
Last updated
12/15/2016
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