MEDICARE: KATHERINE LEWIS PA-C

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	363A00000X	Physician Assistant	3751-23	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PA.0004076	OTHER	CO	COLORADO MEDICAL LICENSE

General Provider Information

NPI Number	:	1992102586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE LEWIS PA-C

Provider Business Mailing Address
First Line	:	N24W24050 BRANDON OAKS DR UNIT A
Second Line	:
City	:	PEWAUKEE
State	:	WI
Zip	:	53072-6429
Country	:	US
Telephone Number	:	915-873-9641
Fax Number	:	262-373-0148

Provider Business Practice Location Address
First Line	:	4111 N PORT WASHINGTON RD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-1029
Country	:	US
Telephone Number	:	414-299-3872
Fax Number	:	414-455-1929

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

Provider Enumeration Date	:	11/25/2014
Last Update Date	:	11/16/2018

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