MEDICARE: DR. BEVERLY RENEE LEWIS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	40744	MN
2	2084P0804X	Child & Adolescent Psychiatry Physician	40744	MN

General Provider Information

NPI Number	:	1144327446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BEVERLY RENEE LEWIS M.D.

Provider Business Mailing Address
First Line	:	333 WASHINGTON AVENUE NORTH
Second Line	:	318 UNION PLAZA
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55401-1367
Country	:	US
Telephone Number	:	612-349-2797
Fax Number	:	612-349-2760

Provider Business Practice Location Address
First Line	:	333 WASHINGTON AVENUE NORTH
Second Line	:	318 UNION PLAZA
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55401-1367
Country	:	US
Telephone Number	:	612-349-2797
Fax Number	:	612-349-2760

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	09/11/2025

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