Provider Demographics
NPI:1346266277
Name:MCFADDEN LEWIS, P JILL (DO)
Entity Type:Individual
Prefix:DR
First Name:P
Middle Name:JILL
Last Name:MCFADDEN LEWIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:PATRICIA
Other - Middle Name:JILL
Other - Last Name:MCFADDEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:5632 LIBERTY CREEK DR W
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-1036
Mailing Address - Country:US
Mailing Address - Phone:317-299-8942
Mailing Address - Fax:317-299-8942
Practice Address - Street 1:5632 LIBERTY CREEK DR W
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-1036
Practice Address - Country:US
Practice Address - Phone:317-299-8942
Practice Address - Fax:317-299-8942
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02000865A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200112150Medicaid