Healthcare Provider Details

I. General information

NPI: 1598763880
Provider Name (Legal Business Name): STEVEN JOSEPH LEWIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 WOODLAND TRL
ROCHESTER IL
62563-9553
US

IV. Provider business mailing address

45 WOODLAND TRL
ROCHESTER IL
62563-9553
US

V. Phone/Fax

Practice location:
  • Phone: 217-836-0766
  • Fax:
Mailing address:
  • Phone: 217-836-0766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036119342
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: