Provider Demographics
NPI:1366466260
Name:LEWIS, RICHARD KENT (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:KENT
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:857 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1720
Mailing Address - Country:US
Mailing Address - Phone:847-295-6786
Mailing Address - Fax:847-295-8636
Practice Address - Street 1:3001 GREEN BAY RD
Practice Address - Street 2:MAIL CODE 116A
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064-3048
Practice Address - Country:US
Practice Address - Phone:224-610-5788
Practice Address - Fax:224-610-3885
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry