Healthcare Provider Details

I. General information

NPI: 1245569482
Provider Name (Legal Business Name): MERRAL LEWIS FAMILY PRACTICE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2009
Last Update Date: 04/20/2010
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 Number
License Number State

VIII. Authorized Official

Name: MERRAL B LEWIS
Title or Position: PRESIDENT
Credential: MD
Phone: 812-425-2461