Provider Demographics
NPI:1760463194
Name:LEWIS, LINDA K (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:K
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:23625 COMMERCE PARK
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122
Mailing Address - Country:US
Mailing Address - Phone:216-255-5701
Mailing Address - Fax:216-255-5701
Practice Address - Street 1:6920 CORTE LANGOSTA
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-6094
Practice Address - Country:US
Practice Address - Phone:216-255-5700
Practice Address - Fax:216-255-5701
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG504332085N0700X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE523625428Medicaid
AZ73383302Medicaid
CA00G504330Medicaid
PA1016646250001Medicaid
SD7705910Medicaid
CA00G504330OtherBCBS
CA300135801OtherRXR MEDICARE
ID806430800Medicaid
OH2309219Medicaid
MT0067496Medicaid
OH2309219Medicaid
CA00G504330Medicaid
MT0067496Medicaid