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General NPI Number Information
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NPI Number | 1891152641
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Entity Type | Individual
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Provider Name | STEPHEN WILLIAM LEWELLIS M.D., PH.D.
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Gender | Male
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Dates
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Enumeration Date | 01/25/2016
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Last Update Date | 05/02/2024
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Provider Practice Location Address
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Address Line | 3750 CORPORATE AVE
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City | PLOVER
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State | WI
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Zip | 54467-3566
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Country | US
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Telephone | 715-391-9774
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Fax | 917-277-4883
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Provider Business Mailing Address
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Address Line | 3002 N 7TH ST
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City | WAUSAU
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State | WI
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Zip | 54403-3003
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Country | US
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Telephone | 715-391-9774
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Fax | 917-277-4883
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 65601
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 75498-20
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License Number State | WI
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