Provider Demographics
NPI:1194762765
Name:LEWIS, GARY S (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:S
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:136 N MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:THIENSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53092-1606
Mailing Address - Country:US
Mailing Address - Phone:262-242-3369
Mailing Address - Fax:262-242-3219
Practice Address - Street 1:136 N MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:THIENSVILLE
Practice Address - State:WI
Practice Address - Zip Code:53092-1606
Practice Address - Country:US
Practice Address - Phone:262-242-3369
Practice Address - Fax:262-242-3219
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2016-06-15
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Provider Licenses
StateLicense IDTaxonomies
WI330004-020207Q00000X
WI33004-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31823100Medicaid
WIF28913Medicare UPIN
WI31823100Medicaid