Lewis, Russell
Lewis, Russell is an individual health care provider with primary practice located at 190 Grand Seasons Dr , Waupaca WI 54981-8219. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Lewis, Russell can be contacted via phone (715) 258-3650.Contact Information
Primary practice address
190 Grand Seasons Dr
Waupaca WI 54981-8219
Phone: (715) 258-3650
Fax: (715) 258-5749
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 4937420 | Wisconsin |
Profile Details
| NPI number | 1255367025 |
|---|---|
| LBN Legal business name | Lewis, Russell |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 24th, 2006 |
| Last updated | May 27th, 2008 - about 18 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 | 1255367025 | NPPES |
| Wisconsin | MEDICAID | 34867900 |
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