MEDICARE: KIRONDA M OWENS-LEWIS 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
1	207Q00000X	Family Medicine Physician	C169115	CA
2	207Q00000X	Family Medicine Physician	051704	GA

General Provider Information

NPI Number	:	1821197377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRONDA M OWENS-LEWIS MD

Provider Business Mailing Address
First Line	:	72780 COUNTRY CLUB DR STE 305
Second Line	:
City	:	RANCHO MIRAGE
State	:	CA
Zip	:	92270-4149
Country	:	US
Telephone Number	:	760-837-8747
Fax Number	:	760-837-8749

Provider Business Practice Location Address
First Line	:	72780 COUNTRY CLUB DR STE 305
Second Line	:
City	:	RANCHO MIRAGE
State	:	CA
Zip	:	92270-4149
Country	:	US
Telephone Number	:	760-837-8747
Fax Number	:	760-837-8749

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

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	03/23/2021

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