Healthcare Provider Details

I. General information

NPI: 1598116378
Provider Name (Legal Business Name): LEWIS ROBERT KINKEAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2016
Last Update Date: 06/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8121 WESTFIELD BLVD
INDIANAPOLIS IN
46240-2654
US

IV. Provider business mailing address

8121 WESTFIELD BLVD
INDIANAPOLIS IN
46240-2654
US

V. Phone/Fax

Practice location:
  • Phone: 317-709-6722
  • Fax:
Mailing address:
  • Phone: 317-709-6722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number01027461A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: