Basic Information
| Provider Information | |||||||||
| NPI: | 1760566293 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LITWACK | ||||||||
| FirstName: | LEWIS | ||||||||
| MiddleName: | J | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2309 | ||||||||
| Address2: | |||||||||
| City: | LAWTON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 735022309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5803579984 | ||||||||
| FaxNumber: | 5803573277 | ||||||||
| Practice Location | |||||||||
| Address1: | 7936 US HWY 277 | ||||||||
| Address2: | |||||||||
| City: | ELGIN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5804926900 | ||||||||
| FaxNumber: | 5804926902 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2006 | ||||||||
| LastUpdateDate: | 07/08/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 24725 | OK | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.