Provider Demographics
NPI:1932201506
Name:LEWIS, DERI MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:DERI
Middle Name:MICHELLE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7777 FOREST LN
Mailing Address - Street 2:STE C208
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-6835
Mailing Address - Country:US
Mailing Address - Phone:972-566-5880
Mailing Address - Fax:972-566-5686
Practice Address - Street 1:7777 FOREST LN
Practice Address - Street 2:C522
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2505
Practice Address - Country:US
Practice Address - Phone:972-566-4880
Practice Address - Fax:972-566-6256
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2021-10-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXM42892086X0206X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology