MEDICARE: VIDA MCGHEE-LEWIS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	01057105A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	M00075599	OTHER	IN	MEDICARE INDIVIDUAL PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083696397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIDA MCGHEE-LEWIS M.D.

Provider Business Mailing Address
First Line	:	9201 CALUMET AVE
Second Line	:
City	:	MUNSTER
State	:	IN
Zip	:	46321-2807
Country	:	US
Telephone Number	:	219-836-2022
Fax Number	:	219-836-0034

Provider Business Practice Location Address
First Line	:	9006 INDIANAPOLIS BLVD
Second Line	:
City	:	HIGHLAND
State	:	IN
Zip	:	46322-2501
Country	:	US
Telephone Number	:	219-923-2241
Fax Number	:	219-838-3455

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	04/18/2014

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Directions to “ VIDA MCGHEE-LEWIS M.D.” Practice Location

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