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General NPI Number Information
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NPI Number | 1639468549
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Entity Type | Individual
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Provider Name | HEIDI LEWIS MD
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Gender | Female
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Dates
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Enumeration Date | 03/31/2011
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Last Update Date | 01/17/2018
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Provider Practice Location Address
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Address Line | 6311 S POINTE BLVD
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City | FORT MYERS
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State | FL
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Zip | 33919-4901
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Country | US
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Telephone | 239-938-3565
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Fax |
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Provider Business Mailing Address
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Address Line | 2335 MEADOW HAVEN ST
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City | HUNTINGTON
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State | WV
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Zip | 25704-9483
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Country | US
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Telephone |
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Fax |
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME17869
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License Number State | FL
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