Individual
DR. ELENA JEAN LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1324 W MILHAM AVE, SUITE 1, PORTAGE, MI 49024-2239
(269) 342-0196
(269) 342-0532
Mailing address
1324 W MILHAM AVE, STE 1, PORTAGE, MI 49024-2239
(269) 341-7806
(269) 341-8743
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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