Provider Demographics
NPI:1467537357
Name:REISMAN, LEWIS (MD)
Entity Type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:
Last Name:REISMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 W. KIRBY PLACE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103
Mailing Address - Country:US
Mailing Address - Phone:318-675-4881
Mailing Address - Fax:318-675-7531
Practice Address - Street 1:1501 KINGS HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103
Practice Address - Country:US
Practice Address - Phone:318-675-8631
Practice Address - Fax:318-675-8634
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA626982080P0210X
LAMD.202441208000000X, 2080P0210X
LA2024412080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1330698Medicaid
NJ6911307Medicaid
NJ6911307Medicaid
NJ529111Medicare PIN
LA4N446CQ62Medicare PIN