Healthcare Provider Details

I. General information

NPI: 1871948109
Provider Name (Legal Business Name): KAREN LEWIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2016
Last Update Date: 04/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N 18TH AVE #120
PHOENIX AZ
85007-3232
US

IV. Provider business mailing address

150 N 18TH AVE #120
PHOENIX AZ
85007-3232
US

V. Phone/Fax

Practice location:
  • Phone: 602-364-3856
  • Fax:
Mailing address:
  • Phone: 602-364-3856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number17137
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: