MEDICARE: MICHELLE YVONNE LEWIS MD

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	207Q00000X	Family Medicine Physician	A112253	CA

General Provider Information

NPI Number	:	1588973523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE YVONNE LEWIS MD

Provider Business Mailing Address
First Line	:	1695 N SUNRISE WAY
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-3701
Country	:	US
Telephone Number	:	760-323-2118
Fax Number	:

Provider Business Practice Location Address
First Line	:	651 N STATE ST
Second Line	:
City	:	SAN JACINTO
State	:	CA
Zip	:	92583-6573
Country	:	US
Telephone Number	:	951-487-8506
Fax Number	:

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

Provider Enumeration Date	:	09/24/2010
Last Update Date	:	11/13/2024

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