Provider Demographics
NPI:1750477808
Name:HARGETT, LEWIS (MD)
Entity Type:Individual
Prefix:
First Name:LEWIS
Middle Name:
Last Name:HARGETT
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:PO BOX 39096
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40233
Mailing Address - Country:US
Mailing Address - Phone:502-366-8021
Mailing Address - Fax:502-366-8235
Practice Address - Street 1:1900 BLUEGRASS AVE
Practice Address - Street 2:STE 100
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215
Practice Address - Country:US
Practice Address - Phone:502-366-8021
Practice Address - Fax:502-366-8235
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26076208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
611273436OtherAARP
KY64260763Medicaid
000000050830OtherANTHEM
250005373OtherMEDICARE RAILROAD
101848640599OtherMEDICAID OF INDIANA
1593613OtherCIGNA
000000060675OtherBLUECROSS
1051604OtherPASSPORT
244240OtherMEDICARE OF INDIANA
KYK156090Medicare PIN
101848640599OtherMEDICAID OF INDIANA