Provider Demographics
NPI:1760466759
Name:LEWIS, LUANNE KEM (MD)
Entity Type:Individual
Prefix:
First Name:LUANNE
Middle Name:KEM
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 1:1395 NW 167TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5710
Mailing Address - Country:US
Mailing Address - Phone:305-628-6117
Mailing Address - Fax:
Practice Address - Street 1:48 NEWMARKET SQ
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23605-2721
Practice Address - Country:US
Practice Address - Phone:757-825-8030
Practice Address - Fax:757-244-9003
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101037230207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5878217Medicaid
VA000231195BDOtherHUMANA HEALTH PLAN
VA74903OtherOPTIMA HEALTH PROVIDER NO
VA119521OtherANTHEM PROVIDER NUMBER
VAC47013Medicare UPIN
VA119521OtherANTHEM PROVIDER NUMBER