Provider Demographics
NPI:1164573150
Name:LAKEWOOD HILLS INTERNAL MEDICINE, LLC
Entity Type:Organization
Organization Name:LAKEWOOD HILLS INTERNAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-875-7770
Mailing Address - Street 1:2203 W LAMPASAS ST
Mailing Address - Street 2:STE 111
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75119-5644
Mailing Address - Country:US
Mailing Address - Phone:972-875-7770
Mailing Address - Fax:972-875-7775
Practice Address - Street 1:2203 W LAMPASAS ST
Practice Address - Street 2:STE 111
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-5644
Practice Address - Country:US
Practice Address - Phone:972-875-7770
Practice Address - Fax:972-875-7775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8125207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherTIN