Healthcare Provider Details

I. General information

NPI: 1861762676
Provider Name (Legal Business Name): DR LISA LEWIS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2012
Last Update Date: 01/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12600 W COLFAX AVE STE A110
LAKEWOOD CO
80215-3785
US

IV. Provider business mailing address

12600 W COLFAX AVE STE A110
LAKEWOOD CO
80215-3785
US

V. Phone/Fax

Practice location:
  • Phone: 303-386-4434
  • Fax:
Mailing address:
  • Phone: 303-386-4434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number28939
License Number StateCO

VIII. Authorized Official

Name: DR. LISA K. LEWIS
Title or Position: PHYSICIAN/OWNER & SECRETARY
Credential: D.O.
Phone: 303-386-4434