Provider Demographics
NPI:1437183811
Name:LEWALLEN, STEVEN ISAAC (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:ISAAC
Last Name:LEWALLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14425 N SHELDON RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-2407
Mailing Address - Country:US
Mailing Address - Phone:734-451-8815
Mailing Address - Fax:734-451-8773
Practice Address - Street 1:46212 BARRINGTON RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-3503
Practice Address - Country:US
Practice Address - Phone:734-451-1836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010309852083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine