Provider Demographics
NPI:1083696397
Name:MCGHEE-LEWIS, VIDA (MD)
Entity Type:Individual
Prefix:
First Name:VIDA
Middle Name:
Last Name:MCGHEE-LEWIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VIDA
Other - Middle Name:
Other - Last Name:MCGHEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9201 CALUMET AVE
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2807
Mailing Address - Country:US
Mailing Address - Phone:219-836-2022
Mailing Address - Fax:219-836-0034
Practice Address - Street 1:9006 INDIANAPOLIS BLVD
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-2501
Practice Address - Country:US
Practice Address - Phone:219-923-2241
Practice Address - Fax:219-838-3455
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057105A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200473010Medicaid
INM00075599OtherMEDICARE INDIVIDUAL PTAN
IN219580AMedicare PIN
IN200473010Medicaid
IN597890Medicare PIN