MEDICARE: WANDA 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	207R00000X	Internal Medicine Physician	ME85702	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245252782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WANDA LEWIS M.D.

Provider Business Mailing Address
First Line	:	827 18TH ST
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-6481
Country	:	US
Telephone Number	:	772-925-8200
Fax Number	:	772-925-8199

Provider Business Practice Location Address
First Line	:	1255 37TH ST STE C
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-6550
Country	:	US
Telephone Number	:	772-494-1770
Fax Number	:	772-494-1774

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	03/04/2025

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