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NPI Code Detail

MEDICARE: RUSSELL LEWIS JR. MD

MEDICARE: RUSSELL LEWIS JR. MD
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
1207Q00000XFamily Medicine Physician4937420WI

Other Identifiers

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

General Provider Information

NPI Number : 1255367025
Entity Type Code : Individual
Provider Name (Legal Business Name) : RUSSELL LEWIS JR. MD
Provider Business Mailing Address
First Line : 900 ILLINOIS AVENUE
Second Line :
City : STEVENS POINT
State : WI
Zip : 54481
Country : US
Telephone Number : 715-346-5000
Fax Number :
Provider Business Practice Location Address
First Line : 190 GRAND SEASONS DR
Second Line :
City : WAUPACA
State : WI
Zip : 54981-8219
Country : US
Telephone Number : 715-258-3650
Fax Number : 715-258-5749
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2006
Last Update Date : 05/27/2008

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