Healthcare Provider Details

I. General information

NPI: 1689674772
Provider Name (Legal Business Name): ROBERT I LEWIS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 04/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 EWING CRAWFIS CIR
BELLEFONTAINE OH
43311-9042
US

IV. Provider business mailing address

2160 EWING CRAWFIS CIR
BELLEFONTAINE OH
43311-9042
US

V. Phone/Fax

Practice location:
  • Phone: 937-593-0070
  • Fax: 937-599-0075
Mailing address:
  • Phone: 937-593-0070
  • Fax: 937-599-0075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number34-003294
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: