Healthcare Provider Details

I. General information

NPI: 1891796751
Provider Name (Legal Business Name): LEWIS CHAMOY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 06/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N MAYFAIR RD SUITE 670
MILWAUKEE WI
53226-1409
US

IV. Provider business mailing address

2500 N MAYFAIR RD SUITE 670
MILWAUKEE WI
53226-1409
US

V. Phone/Fax

Practice location:
  • Phone: 414-453-7418
  • Fax: 414-453-7420
Mailing address:
  • Phone: 414-453-7418
  • Fax: 414-453-7420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number16789
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: