Provider Demographics
NPI:1740212554
Name:LEWIS, CHRISTIE C (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:C
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:793 EASTERN BYPAS
Mailing Address - Street 2:SUITE 110
Mailing Address - City:RICHMOND
Mailing Address - State:LA
Mailing Address - Zip Code:40475
Mailing Address - Country:US
Mailing Address - Phone:859-624-2020
Mailing Address - Fax:859-623-7362
Practice Address - Street 1:793 EASTERN BYP
Practice Address - Street 2:SUITE 110
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2422
Practice Address - Country:US
Practice Address - Phone:859-624-2020
Practice Address - Fax:859-623-7362
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY21423208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics