Healthcare Provider Details

I. General information

NPI: 1144327446
Provider Name (Legal Business Name): BEVERLY RENEE LEWIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 WASHINGTON AVENUE NORTH 318 UNION PLAZA
MINNEAPOLIS MN
55401-1367
US

IV. Provider business mailing address

333 WASHINGTON AVENUE NORTH 318 UNION PLAZA
MINNEAPOLIS MN
55401-1367
US

V. Phone/Fax

Practice location:
  • Phone: 612-349-2797
  • Fax: 612-349-2760
Mailing address:
  • Phone: 612-349-2797
  • Fax: 612-349-2760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number40744
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number40744
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: