MEDICARE: ERNEST C 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	207RX0202X	Medical Oncology Physician	46104	WI
2	207RX0202X	Medical Oncology Physician	4301082745	MI
3	207RX0202X	Medical Oncology Physician	2008020485	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00635672	OTHER	MO	TRAVELERS RR MEDICARE

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	EL082745	OTHER	MI	BCBS MI

General Provider Information

NPI Number	:	1457445579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERNEST C LEWIS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 13453
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54307-3453
Country	:	US
Telephone Number	:	920-432-6049
Fax Number	:	920-884-3271

Provider Business Practice Location Address
First Line	:	2115 S FREMONT AVE
Second Line	:	SUITE 1000
City	:	SPRINGFIELD
State	:	MO
Zip	:	65804-2239
Country	:	US
Telephone Number	:	417-820-8099
Fax Number	:	417-820-8093

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	12/04/2008

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