Provider Demographics
NPI:1881856268
Name:LEWIS, GRETCHEN ANN (DO)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:ANN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:GRETCHEN
Other - Middle Name:ANN LEWIS
Other - Last Name:KLEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:500 EAST MARKET STREET
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245
Mailing Address - Country:US
Mailing Address - Phone:319-339-0300
Mailing Address - Fax:319-339-3906
Practice Address - Street 1:269 NORTH 1ST AVENUE
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245
Practice Address - Country:US
Practice Address - Phone:319-351-6852
Practice Address - Fax:319-688-7565
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT032.0079941207Q00000X
IADO-05329207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA036134458Medicaid