Healthcare Provider Details

I. General information

NPI: 1568842284
Provider Name (Legal Business Name): KELSEY E LEWIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2015
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6949 GOOD SAMARITAN DR # 2
CINCINNATI OH
45247-5204
US

IV. Provider business mailing address

6949 GOOD SAMARITAN DR # 2
CINCINNATI OH
45247-5204
US

V. Phone/Fax

Practice location:
  • Phone: 513-463-4300
  • Fax: 513-463-4310
Mailing address:
  • Phone: 513-463-4300
  • Fax: 513-463-4310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberBP10052640
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35.142807
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number35.142807
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: