MEDICARE: DR. ELLEN 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	2084P0804X	Child & Adolescent Psychiatry Physician	20785	CO

General Provider Information

NPI Number	:	1255307757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELLEN LEWIS M.D.

Provider Business Mailing Address
First Line	:	425 S CHERRY ST
Second Line	:	#600
City	:	DENVER
State	:	CO
Zip	:	80246-1226
Country	:	US
Telephone Number	:	303-399-9214
Fax Number	:	303-355-5707

Provider Business Practice Location Address
First Line	:	425 S CHERRY ST
Second Line	:	#600
City	:	DENVER
State	:	CO
Zip	:	80246-1226
Country	:	US
Telephone Number	:	303-399-9214
Fax Number	:	303-355-5707

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

Provider Enumeration Date	:	02/24/2006
Last Update Date	:	07/08/2007

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