Provider Demographics
NPI:1871672931
Name:LEWIS, MICHELLE MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:MARIE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 N GREEN VALLEY PKWY STE 3A
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-5886
Mailing Address - Country:US
Mailing Address - Phone:702-566-3040
Mailing Address - Fax:702-361-2813
Practice Address - Street 1:1701 N GREEN VALLEY PKWY STE 3A
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-5886
Practice Address - Country:US
Practice Address - Phone:702-566-3040
Practice Address - Fax:702-361-2813
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO720207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002019372Medicaid
NVVDO720AMedicare PIN
NV002019372Medicaid