Individual
MARCUS LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1550 E UNIVERSITY DR, SUITE G, MESA, AZ 85203-8136
(602) 369-3497
(480) 921-4115
Mailing address
1550 E UNIVERSITY DR, SUITE G, MESA, AZ 85203-8136
(602) 369-3497
(480) 921-4115
Taxonomy
Speciality
Code
Description
License number
State
405300000X
Prevention Professional
Primary
81-5054569
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
81-5054569
—
AZ
Enumeration date
03/10/2017
Last updated
03/10/2017
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