Provider Demographics
NPI:1760678601
Name:LEWIS, MICHAEL LUVERNE (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LUVERNE
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3901 RAINBOW BLVD
Mailing Address - Street 2:MILLER 2013
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-0001
Mailing Address - Country:US
Mailing Address - Phone:913-484-7010
Mailing Address - Fax:913-588-6280
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:MILLER 2013
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-0001
Practice Address - Country:US
Practice Address - Phone:913-588-6917
Practice Address - Fax:913-588-6280
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS94-06896208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics