Provider Demographics
NPI:1134232283
Name:LEWIS, PHYLLIS A (MD)
Entity type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:A
Last Name:LEWIS
Suffix:
Gender:F
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:KY CHILDRENS HOSPITAL DEPT OF PEDIATRICS
Mailing Address - Street 2:800 ROSE ST.
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0001
Mailing Address - Country:US
Mailing Address - Phone:859-323-5962
Mailing Address - Fax:
Practice Address - Street 1:KY CHILDRENS HOSPITAL DEPT OF PEDIATRICS
Practice Address - Street 2:800 ROSE ST.
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0001
Practice Address - Country:US
Practice Address - Phone:859-323-5962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY23228208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics