Provider Demographics
NPI:1437661204
Name:LEWIS, MICHELLE DENISE (BAT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DENISE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:BAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 W COMMERCE ST FL 5
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73521-3850
Mailing Address - Country:US
Mailing Address - Phone:580-482-2809
Mailing Address - Fax:
Practice Address - Street 1:123 W COMMERCE ST FL 5
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-3850
Practice Address - Country:US
Practice Address - Phone:580-482-2809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-01
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator