Lewis, Kevan G
Lewis, Kevan G is an individual health care provider with primary practice located at 3059 Voyager Dr , Green Bay WI 54311-8303. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Dermatology, Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery. Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery is his primary health care specialty. Lewis, Kevan G can be contacted via phone (920) 965-0345.Contact Information
Primary practice address
3059 Voyager Dr
Green Bay WI 54311-8303
Phone: (920) 965-0345
Fax: (920) 257-4559
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Dermatology | 207N00000X | 53110-20 | Wisconsin |
| Allopathic & Osteopathic Physicians / Dermatology | 207N00000X | 51745 | Minnesota |
| Allopathic & Osteopathic Physicians / Dermatology | 207N00000X | LP00514 | Rhode Island |
| Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery | 207ND0101X | 53110-020 | Wisconsin |
Profile Details
| NPI number | 1497970560 |
|---|---|
| LBN Legal business name | Lewis, Kevan G |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 16th, 2007 |
| Last updated | Mar 7th, 2023 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1497970560 | NPPES |
| Iowa | MEDICAID | ENROLLED | |
| Iowa | Other | P00787809 | |
| Iowa | MEDICAID | 1497970560 | |
| Iowa | Other | 53110-020 | |
| Iowa | MEDICAID | ENROLLED |
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