Basic Information
Provider Information
NPI: 1548422272
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: POPAT - LEWIS
FirstName: BINDU
MiddleName: UPENDRA
NamePrefix:  
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5555 GLENWOOD HILLS PKWY SE STE 2
Address2:  
City: GRAND RAPIDS
State: MI
PostalCode: 495122091
CountryCode: US
TelephoneNumber: 6169402662
FaxNumber: 6169401965
Practice Location
Address1: 2060 E PARIS AVE SE STE 200
Address2:  
City: GRAND RAPIDS
State: MI
PostalCode: 495466113
CountryCode: US
TelephoneNumber: 6162851377
FaxNumber: 6162851154
Other Information
ProviderEnumerationDate: 06/25/2008
LastUpdateDate: 05/04/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/04/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X5101017716MIN Allopathic & Osteopathic PhysiciansAnesthesiology 
208VP0000X5101017716MIY Allopathic & Osteopathic PhysiciansPain MedicinePain Medicine

No ID Information.


Home