Basic Information
| Provider Information | |||||||||
| NPI: | 1518055342 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MIDWALL | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | LEWIS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5503 S CONGRESS AVE | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | ATLANTIS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334626625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614330591 | ||||||||
| FaxNumber: | 5614330891 | ||||||||
| Practice Location | |||||||||
| Address1: | 5503 S CONGRESS AVE | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | ATLANTIS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334626625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614330591 | ||||||||
| FaxNumber: | 5614330891 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2006 | ||||||||
| LastUpdateDate: | 01/23/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | MD445890 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RI0011X | MD445890 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 207RI0011X | ME99154 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 14X38 | 01 | FL | BCBS | OTHER | 011685000 | 05 | FL | MEDICAID | 102827028 | 05 | PA | MEDICAID |