Provider Demographics
NPI:1700869161
Name:LEWIS, PETER M (DO)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:M
Last Name:LEWIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 MIAMISBURG CENTERVILLE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-7615
Mailing Address - Country:US
Mailing Address - Phone:937-866-0637
Mailing Address - Fax:937-866-6713
Practice Address - Street 1:4000 MIAMISBURG CENTERVILLE RD
Practice Address - Street 2:SUTIE 100
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-7615
Practice Address - Country:US
Practice Address - Phone:937-866-0637
Practice Address - Fax:937-866-6713
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH340004753207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00058864OtherRAILROAD MEDICARE
OH0898195Medicaid
OH000000223050OtherANTHEM BC/BS
OHH002800Medicare PIN
OHF43908Medicare UPIN
OH0729016Medicare UPIN
OH0729015Medicare PIN