Provider Demographics
NPI:1073589412
Name:LEWIS, KIMBERLY HARRIS (DPM)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:HARRIS
Last Name:LEWIS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10625 DEAUVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-4004
Mailing Address - Country:US
Mailing Address - Phone:770-733-7560
Mailing Address - Fax:
Practice Address - Street 1:10625 DEAUVILLE RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240-4004
Practice Address - Country:US
Practice Address - Phone:770-733-7560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-26
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001018213E00000X
OH003766213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA131408692AMedicaid
GAGRP7182Medicare PIN
U91325Medicare UPIN
GA48SCCRWMedicare PIN
GA131408692AMedicaid