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General NPI Number Information
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NPI Number | 1295979474
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Entity Type | Individual
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Provider Name | LEWIS JEREMY JOHNSON DO
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Gender | Male
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Dates
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Enumeration Date | 05/01/2009
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 210 N TILLOTSON AVE
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City | MUNCIE
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State | IN
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Zip | 47304-3988
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Country | US
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Telephone | 765-747-4332
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Fax | 765-448-7689
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Provider Business Mailing Address
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Address Line | 210 N TILLOTSON AVE
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City | MUNCIE
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State | IN
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Zip | 47304-3988
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Country | US
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Telephone | 765-747-4332
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Fax | 765-448-7689
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 5101017835
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 3622
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 02006859A
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License Number State | IN
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