Healthcare Provider Details

I. General information

NPI: 1225094246
Provider Name (Legal Business Name): TIMOTHY M LEWAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11552 SHERIDAN BLVD
WESTMINSTER CO
80020-3302
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 303-469-6000
  • Fax: 303-469-2922
Mailing address:
  • Phone: 719-463-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number39800
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: