Provider Demographics
NPI:1346566775
Name:LEWIS, JOHN STRUDWICK JR (MD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:STRUDWICK
Last Name:LEWIS
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:4130 DUTCHMANS LN
Mailing Address - Street 2:STE 300
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4713
Mailing Address - Country:US
Mailing Address - Phone:502-897-1794
Mailing Address - Fax:502-238-1286
Practice Address - Street 1:4130 DUTCHMANS LN
Practice Address - Street 2:STE 300
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4713
Practice Address - Country:US
Practice Address - Phone:502-897-1794
Practice Address - Fax:502-238-1286
Is Sole Proprietor?:No
Enumeration Date:2010-04-09
Last Update Date:2016-09-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
KYTP263207X00000X
NC2015-00487207X00000X
IN99073144A207X00000X
IN01077284A207X00000X
KY49582207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNC2399Medicaid
IN201360210Medicaid
KY7100416000Medicaid
NC1346566775Medicaid
NCNCN336AMedicare PIN
ININ1920019Medicare PIN
KY7100416000Medicaid
NC1346566775Medicaid