Provider Demographics
NPI:1083687693
Name:LEWAN, RICHARD B JR (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:B
Last Name:LEWAN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 598
Mailing Address - Street 2:
Mailing Address - City:KALAHEO
Mailing Address - State:HI
Mailing Address - Zip Code:96741-0598
Mailing Address - Country:US
Mailing Address - Phone:808-346-2602
Mailing Address - Fax:808-245-9367
Practice Address - Street 1:9611 WAENA ROAD
Practice Address - Street 2:
Practice Address - City:WAIMEA
Practice Address - State:HI
Practice Address - Zip Code:96796
Practice Address - Country:US
Practice Address - Phone:808-338-1681
Practice Address - Fax:808-245-9367
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI24568207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIB54566Medicare UPIN