Healthcare Provider Details

I. General information

NPI: 1073589412
Provider Name (Legal Business Name): KIMBERLY HARRIS LEWIS D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2006
Last Update Date: 05/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10625 DEAUVILLE RD
CINCINNATI OH
45240-4004
US

IV. Provider business mailing address

10625 DEAUVILLE RD
CINCINNATI OH
45240-4004
US

V. Phone/Fax

Practice location:
  • Phone: 770-733-7560
  • Fax:
Mailing address:
  • Phone: 770-733-7560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPOD001018
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number003766
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: