Provider Demographics
NPI:1417775099
Name:LEWINSKI, MICHAEL A (PHD, D(ABMM), CM, MB)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:LEWINSKI
Suffix:
Gender:M
Credentials:PHD, D(ABMM), CM, MB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 VIA UMBROSO
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-6013
Mailing Address - Country:US
Mailing Address - Phone:949-275-7588
Mailing Address - Fax:
Practice Address - Street 1:16 GOODYEAR STE 100
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3757
Practice Address - Country:US
Practice Address - Phone:800-522-7740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMTE670246QM0900X
IL669246Z00000X
CADRI044207ZM0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZM0300XAllopathic & Osteopathic PhysiciansPathologyMedical Microbiology
No246QM0900XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMicrobiology
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other