Healthcare Provider Details

I. General information

NPI: 1548420425
Provider Name (Legal Business Name): MATTHEW CRAIG LEWIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2008
Last Update Date: 02/10/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7150 CLEARVISTA DR
INDIANAPOLIS IN
46256-1695
US

IV. Provider business mailing address

PO BOX 1026
INDIANAPOLIS IN
46206-1026
US

V. Phone/Fax

Practice location:
  • Phone: 317-274-4715
  • Fax: 317-274-2065
Mailing address:
  • Phone: 317-274-1201
  • Fax: 317-278-9905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number01071212
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: