Provider Demographics
NPI:1164659322
Name:LEWIS, KAREN ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:ELIZABETH
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-8720
Mailing Address - Fax:
Practice Address - Street 1:16525 HOLLY CREST LN STE 150
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-4911
Practice Address - Country:US
Practice Address - Phone:704-384-8720
Practice Address - Fax:704-384-8747
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD034642208000000X
TXN3827208000000X
NC2018-00013208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8BQ433OtherBLUE CROSS BLUE SHIELD