MEDICARE: MICHAEL LUVERNE 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	208000000X	Pediatrics Physician	94-06896	KS

General Provider Information

NPI Number	:	1760678601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL LUVERNE LEWIS M.D.

Provider Business Mailing Address
First Line	:	3901 RAINBOW BLVD
Second Line	:	MILLER 2013
City	:	KANSAS CITY
State	:	KS
Zip	:	66160-0001
Country	:	US
Telephone Number	:	913-484-7010
Fax Number	:	913-588-6280

Provider Business Practice Location Address
First Line	:	3901 RAINBOW BLVD
Second Line	:	MILLER 2013
City	:	KANSAS CITY
State	:	KS
Zip	:	66160-0001
Country	:	US
Telephone Number	:	913-588-6917
Fax Number	:	913-588-6280

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

Provider Enumeration Date	:	09/24/2007
Last Update Date	:	12/29/2010

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