Provider Demographics
NPI:1396721668
Name:LEWIS, CHRISTOPHER GEORGE (DO)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:GEORGE
Last Name:LEWIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 BAPTISTE DR
Mailing Address - Street 2:SUITE #D
Mailing Address - City:PAOLA
Mailing Address - State:KS
Mailing Address - Zip Code:66071-1314
Mailing Address - Country:US
Mailing Address - Phone:913-557-0700
Mailing Address - Fax:913-557-9088
Practice Address - Street 1:2102 BAPTISTE DR
Practice Address - Street 2:SUITE #D
Practice Address - City:PAOLA
Practice Address - State:KS
Practice Address - Zip Code:66071-1314
Practice Address - Country:US
Practice Address - Phone:913-557-0700
Practice Address - Fax:913-557-9088
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0531491208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200337110AMedicaid
KS200337110AMedicaid
KS105014Medicare ID - Type Unspecified