Healthcare Provider Details

I. General information

NPI: 1043222532
Provider Name (Legal Business Name): KEVIN LANE LEWIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 05/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 S UTICA AVE THIRD FLOOR
TULSA OK
74104-4243
US

IV. Provider business mailing address

1265 S UTICA AVE THIRD FLOOR
TULSA OK
74104-4243
US

V. Phone/Fax

Practice location:
  • Phone: 918-592-0999
  • Fax: 918-592-1021
Mailing address:
  • Phone: 918-592-0999
  • Fax: 918-592-1021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number19949
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number19949
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number19949
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: