Provider Demographics
NPI:1134208523
Name:LEWIS, GINA (DO)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
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:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-643-4374
Mailing Address - Fax:515-643-2784
Practice Address - Street 1:5900 E UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:IA
Practice Address - Zip Code:50327-8457
Practice Address - Country:US
Practice Address - Phone:515-643-2400
Practice Address - Fax:515-643-4766
Is Sole Proprietor?:No
Enumeration Date:2006-11-04
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8870207Q00000X
IA3532207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1932415OtherGREAT WEST
CA90198225OtherPACIFICARE
CA2689213OtherUNITED HEALTHCARE
IA70271OtherWELLMARK BLUE SHIELD
IA0400165Medicaid
CA20A8870OtherBLUE CROSS
CA00AX88700Medicaid
CA161241OtherINTERPLAN
IAI22004Medicare PIN
CA020A88700Medicare ID - Type Unspecified
IA0400165Medicaid