Provider Demographics
NPI:1316950223
Name:LEWIN, DAVID S (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:S
Last Name:LEWIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2300 N LINCOLN PARK W
Mailing Address - Street 2:#622
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-3456
Mailing Address - Country:US
Mailing Address - Phone:773-909-0379
Mailing Address - Fax:708-923-3611
Practice Address - Street 1:11800 SOUTHWEST HWY
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1029
Practice Address - Country:US
Practice Address - Phone:708-361-0220
Practice Address - Fax:708-923-3611
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G47223Medicare UPIN
L85525Medicare ID - Type Unspecified