Provider Demographics
NPI:1124021555
Name:LEWIS, MERRAL B (MD)
Entity Type:Individual
Prefix:
First Name:MERRAL
Middle Name:B
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1230
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47706-1230
Mailing Address - Country:US
Mailing Address - Phone:812-425-2461
Mailing Address - Fax:812-424-7254
Practice Address - Street 1:350 W COLUMBIA ST
Practice Address - Street 2:STE 440
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1782
Practice Address - Country:US
Practice Address - Phone:812-425-2461
Practice Address - Fax:812-424-7254
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2011-03-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01027625A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100242820Medicaid
IN267080AMedicare PIN
INE32964Medicare UPIN