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NPI Code Detail

MEDICARE: DR. JUSTIN ROBERT LEWIS M.D.

MEDICARE: DR. JUSTIN ROBERT 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
12085R0202XDiagnostic Radiology Physician01073700AIN
22085R0202XDiagnostic Radiology Physician15585NH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1528228228
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JUSTIN ROBERT LEWIS M.D.
Provider Business Mailing Address
First Line : 1481 W 10TH ST
Second Line : RICHARD ROUDEBUSH VA MEDICAL CENTER
City : INDIANAPOLIS
State : IN
Zip : 46202-2803
Country : US
Telephone Number : 317-554-0000
Fax Number :
Provider Business Practice Location Address
First Line : 1481 W 10TH ST
Second Line : RICHARD ROUDEBUSH VA MEDICAL CENTER
City : INDIANAPOLIS
State : IN
Zip : 46202-2803
Country : US
Telephone Number : 317-554-0000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2008
Last Update Date : 01/13/2026

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