Provider Demographics
NPI:1538201892
Name:LEWIS, CASEY MILES (MD)
Entity type:Individual
Prefix:DR
First Name:CASEY
Middle Name:MILES
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 CEDAR GROVE RD STE 20
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-8592
Mailing Address - Country:US
Mailing Address - Phone:502-215-5090
Mailing Address - Fax:502-215-5095
Practice Address - Street 1:1707 CEDAR GROVE RD STE 20
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-8592
Practice Address - Country:US
Practice Address - Phone:502-215-5090
Practice Address - Fax:502-215-5095
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41599208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200922040Medicaid
KY7100047810Medicaid
KY0773381Medicare PIN