Provider Demographics
NPI:1396761219
Name:LEWIS, KATHERINE J (MD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:J
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4033 TAMPA RD
Mailing Address - Street 2:STE. 101
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-3224
Mailing Address - Country:US
Mailing Address - Phone:813-854-2003
Mailing Address - Fax:813-855-2367
Practice Address - Street 1:3222 W AZEELE ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-3280
Practice Address - Country:US
Practice Address - Phone:813-872-8491
Practice Address - Fax:813-872-7766
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME43232208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL069691900Medicaid
D85564Medicare UPIN