MEDICARE: DR. MICHELLE MARIE LEWIS D.O.

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	207V00000X	Obstetrics & Gynecology Physician	DO720	NV

Other Identifiers

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

General Provider Information

NPI Number	:	1871672931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE MARIE LEWIS D.O.

Provider Business Mailing Address
First Line	:	1701 N GREEN VALLEY PKWY STE 3A
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-5886
Country	:	US
Telephone Number	:	702-566-3040
Fax Number	:	702-361-2813

Provider Business Practice Location Address
First Line	:	1701 N GREEN VALLEY PKWY STE 3A
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-5886
Country	:	US
Telephone Number	:	702-566-3040
Fax Number	:	702-361-2813

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

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	02/28/2023

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