Active NPI
Edgar Lewis III, C.O.
- Prosthetic/Orthotic Supplier
- Livonia, MI
National Provider Identifier
1063823540
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthetic/Orthotic Supplier
- License
- CO0004213
- Practice address
- 16988 Farmington Rd
Livonia, MI 48154-2973 - Phone
- (248) 227-1408
- NPI assigned
- May 19, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthetic/Orthotic Supplier | 335E00000X | CO0004213 | MI | Primary |
Addresses
Primary practice location
16988 Farmington Rd
Livonia, MI 48154-2973
Mailing address
16988 Farmington Rd
Livonia, MI 48154-2973
Phone (248) 227-1408
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CO0004213 | MI | MD | Prosthetic/Orthotic Supplier |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1400457600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1400457600000",
"number": "1063823540",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16988 FARMINGTON RD",
"city": "LIVONIA",
"state": "MI",
"postal_code": "481542973",
"telephone_number": "248-227-1408"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16988 FARMINGTON RD",
"city": "LIVONIA",
"state": "MI",
"postal_code": "481542973",
"telephone_number": "248-227-1408"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEWIS",
"first_name": "EDGAR",
"name_suffix": "III",
"credential": "C.O.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-05-19",
"last_updated": "2014-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "335E00000X",
"taxonomy_group": "",
"desc": "Prosthetic/Orthotic Supplier",
"state": "MI",
"license": "CO0004213",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Livonia, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.