Healthcare Provider Details

I. General information

NPI: 1902509714
Provider Name (Legal Business Name): REBECCA LAURY LEWIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

571 S FLOYD ST STE 414
LOUISVILLE KY
40202-3877
US

IV. Provider business mailing address

571 S FLOYD ST STE 414
LOUISVILLE KY
40202-3877
US

V. Phone/Fax

Practice location:
  • Phone: 502-852-3772
  • Fax:
Mailing address:
  • Phone: 502-852-3772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125.081309
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: