Provider Demographics
NPI:1639589302
Name:LEWIS, WESLEY KREIG (DPM)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:KREIG
Last Name:LEWIS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2066 W APACHE TRL STE 110
Mailing Address - Street 2:
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85120-3733
Mailing Address - Country:US
Mailing Address - Phone:480-597-1751
Mailing Address - Fax:
Practice Address - Street 1:2066 W APACHE TRL STE 110
Practice Address - Street 2:
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85120-3733
Practice Address - Country:US
Practice Address - Phone:480-710-3816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-05
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMT-1448213ES0103X
AZ980213ES0103X
AZ866213ES0103X
AZPOD-000980213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ278161Medicaid