Provider Demographics
NPI:1942475553
Name:LEWIS, MICHELL KATHERINE (CD, RD)
Entity Type:Individual
Prefix:MRS
First Name:MICHELL
Middle Name:KATHERINE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:CD, RD
Other - Prefix:MISS
Other - First Name:MICHELL
Other - Middle Name:KATHERINE
Other - Last Name:MCCASTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8888 KEYSTONE XING
Mailing Address - Street 2:STE 1300
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-4600
Mailing Address - Country:US
Mailing Address - Phone:317-296-7730
Mailing Address - Fax:317-545-1877
Practice Address - Street 1:6330 E 75TH ST
Practice Address - Street 2:STE 174
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2781
Practice Address - Country:US
Practice Address - Phone:317-296-7730
Practice Address - Fax:317-545-1877
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37001737A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered