Provider Demographics
NPI:1801418280
Name:LEWIS, TREVOR JAMES (DO)
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:JAMES
Last Name:LEWIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY HOSPITALS ST. JOHN MEDICAL CENTER
Mailing Address - Street 2:29000 CENTER RIDGE ROAD
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:29000 CENTER RIDGE ROAD
Practice Address - Street 2:BLDG 2, STE 150
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145
Practice Address - Country:US
Practice Address - Phone:440-827-5261
Practice Address - Fax:440-827-5573
Is Sole Proprietor?:No
Enumeration Date:2020-05-08
Last Update Date:2023-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH34.016213207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program