Provider Demographics
NPI:1285776864
Name:LEWIS, KENNETH C (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:C
Last Name:LEWIS
Suffix:
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 4433
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81502-4433
Mailing Address - Country:US
Mailing Address - Phone:970-254-1686
Mailing Address - Fax:
Practice Address - Street 1:2460 PATTERSON RD UNIT 4
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1027
Practice Address - Country:US
Practice Address - Phone:970-254-1686
Practice Address - Fax:970-858-0798
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO33466207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO12650862Medicaid
LE668943OtherBLUE CROSS
P00180467OtherRAILROAD MEDICARE
CO12650862Medicaid
LE668943OtherBLUE CROSS