Healthcare Provider Details

I. General information

NPI: 1124021555
Provider Name (Legal Business Name): MERRAL B LEWIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 03/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 W COLUMBIA ST STE 440
EVANSVILLE IN
47710-1782
US

IV. Provider business mailing address

PO BOX 1230
EVANSVILLE IN
47706-1230
US

V. Phone/Fax

Practice location:
  • Phone: 812-425-2461
  • Fax: 812-424-7254
Mailing address:
  • Phone: 812-425-2461
  • Fax: 812-424-7254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01027625A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: