Provider Demographics
NPI:1699753236
Name:ROBERSON, LEWIS HARVEY II (MD)
Entity type:Individual
Prefix:
First Name:LEWIS
Middle Name:HARVEY
Last Name:ROBERSON
Suffix:II
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:
Practice Address - Street 1:10620 PARK RD
Practice Address - Street 2:STE 202
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8472
Practice Address - Country:US
Practice Address - Phone:704-667-0920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI84564-20207Q00000X
IL036171702207Q00000X
NC9500705207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100295161Medicaid
SCNC2524Medicaid
NC8971937Medicaid
NC2215125HMedicare PIN
NC1699753236Medicaid
NC2215125JMedicare PIN
NC2215125SMedicare PIN
NC2215125EMedicare PIN
NC2215125BMedicare PIN
SCNC2524Medicaid
NC2215125FMedicare PIN
NC2215125GMedicare PIN
NC2215125KMedicare PIN
NC2215125LMedicare PIN
NC2215125PMedicare PIN
NC2215125RMedicare PIN
NC2215125CMedicare PIN
NC8971937Medicaid
NC2215125NMedicare PIN
NC2215125QMedicare PIN
NCNC4883AMedicare PIN
NC2215125AMedicare PIN
NC2215125DMedicare PIN