Provider Demographics
NPI:1023182292
Name:LEWIS, LISA K (DO)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:K
Last Name:LEWIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12600 W COLFAX AVE
Mailing Address - Street 2:STE A110
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-3785
Mailing Address - Country:US
Mailing Address - Phone:303-386-4434
Mailing Address - Fax:303-362-8758
Practice Address - Street 1:12600 W COLFAX AVE
Practice Address - Street 2:STE A110
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-3785
Practice Address - Country:US
Practice Address - Phone:303-386-4434
Practice Address - Fax:303-362-8758
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO 28939207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01289396Medicaid
COT9878Medicare PIN
CO01289396Medicaid