Healthcare Provider Details

I. General information

NPI: 1164330734
Provider Name (Legal Business Name): QUINN LEW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3604 MONTEBELLO DR W
COLORADO SPRINGS CO
80918-2324
US

IV. Provider business mailing address

14400 BOGERT PKWY
OKLAHOMA CITY OK
73134-2652
US

V. Phone/Fax

Practice location:
  • Phone: 918-720-4882
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: