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NPI Code Detail

MEDICARE: DR. IVY LEWIS M.D.

MEDICARE: DR. IVY 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
1208600000XSurgery Physician87156MT
2208600000XSurgery Physician56791KY

General Provider Information

NPI Number : 1336535301
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. IVY LEWIS M.D.
Provider Business Mailing Address
First Line : PO BOX 776351
Second Line :
City : CHICAGO
State : IL
Zip : 60677-6351
Country : US
Telephone Number : 502-588-9490
Fax Number : 502-272-5116
Provider Business Practice Location Address
First Line : 3 AUDUBON PLAZA DR STE LL2
Second Line :
City : LOUISVILLE
State : KY
Zip : 40217-1360
Country : US
Telephone Number : 502-637-3311
Fax Number : 502-637-3168
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2015
Last Update Date : 09/06/2024

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Directions to “ DR. IVY LEWIS M.D.” Practice Location

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