Provider Demographics
NPI:1588676944
Name:EDMUNG J. LEWIS M D AND ASSOCIATES
Entity type:Organization
Organization Name:EDMUNG J. LEWIS M D AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANISH
Authorized Official - Middle Name:
Authorized Official - Last Name:TANNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-573-5000
Mailing Address - Street 1:PO BOX 72362
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44192-0002
Mailing Address - Country:US
Mailing Address - Phone:331-216-1171
Mailing Address - Fax:
Practice Address - Street 1:104 S ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2402
Practice Address - Country:US
Practice Address - Phone:312-850-8434
Practice Address - Fax:312-829-3887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36045051207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1615381OtherBCBS P PROVIDER NUMBER
GA110042308OtherRAILROAD MEDICARE
IL=========Medicaid
IL469280Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER