Provider Demographics
NPI:1407956089
Name:VIOLA-LEWIS, MECHELLE D (MD)
Entity Type:Individual
Prefix:DR
First Name:MECHELLE
Middle Name:D
Last Name:VIOLA-LEWIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MECHELLE
Other - Middle Name:D
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1433 FRANCES HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:VALIER
Mailing Address - State:MT
Mailing Address - Zip Code:59486-5471
Mailing Address - Country:US
Mailing Address - Phone:406-941-0686
Mailing Address - Fax:
Practice Address - Street 1:550 THORNTON PKWY UNIT 110
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-2166
Practice Address - Country:US
Practice Address - Phone:720-872-0399
Practice Address - Fax:702-872-0421
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009014177207R00000X, 208000000X
MT12457207R00000X, 208000000X
CODR.0069712207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYI6252Medicare UPIN
KY0998815Medicare PIN
WYW24572Medicare PIN