Individual
LARRY S LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1414 W FAIR AVENUE, SUITE 230, MARQUETTE, MI 49855-2675
(906) 225-3853
(906) 228-4065
Mailing address
1414 W/ FAIR AVENUE, SUITE 230, MARQUETTE, MI 49855-2675
(906) 225-3853
(906) 228-4065
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
LL042094
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0E26017
BLUE CROSS/BLUE SHIELD
MI
05
—
1944751
—
MI
Enumeration date
06/28/2005
Last updated
07/10/2010
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