Provider Demographics
NPI:1740286590
Name:LEWIS, JEFFREY R (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:R
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7045 LIGHTHOUSE WAY
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-7000
Mailing Address - Country:US
Mailing Address - Phone:419-873-6836
Mailing Address - Fax:419-873-6837
Practice Address - Street 1:2051 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3948
Practice Address - Country:US
Practice Address - Phone:419-291-2051
Practice Address - Fax:419-479-6952
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2018-05-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35051429207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6895OtherHPM
OH000000030933OtherANTHEM WWK
OH344428256080OtherCARESOURCES
OH4091OtherNATIONWIDE
OH4002483OtherAETNA
MI4002483OtherPPOM
OH142072OtherCARE CHOICES
OH142072OtherPRIORITY
OH000000296936OtherANTHEM CHS
OH01-04068OtherUNITED
OH0877047Medicaid
OH1078435002OtherCIGNA
MI344428256OtherPHCS
OH0877047Medicaid
OHLE7182501Medicare PIN
OH142072OtherCARE CHOICES