Provider Demographics
NPI:1023469194
Name:LEWI, KEIDREN (MD)
Entity type:Individual
Prefix:
First Name:KEIDREN
Middle Name:
Last Name:LEWI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3157 FARNAM ST
Mailing Address - Street 2:7729
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-3568
Mailing Address - Country:US
Mailing Address - Phone:402-680-8777
Mailing Address - Fax:
Practice Address - Street 1:601 N 30TH ST
Practice Address - Street 2:CU DEPARTMENT OF FAMILY MEDICINE
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2128
Practice Address - Country:US
Practice Address - Phone:402-280-2010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7690207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine