Provider Demographics
NPI:1891796751
Name:CHAMOY, LEWIS (MD)
Entity type:Individual
Prefix:
First Name:LEWIS
Middle Name:
Last Name:CHAMOY
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 1:2500 N MAYFAIR RD
Mailing Address - Street 2:SUITE 670
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1409
Mailing Address - Country:US
Mailing Address - Phone:414-453-7418
Mailing Address - Fax:414-453-7420
Practice Address - Street 1:2500 N MAYFAIR RD
Practice Address - Street 2:SUITE 670
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-1409
Practice Address - Country:US
Practice Address - Phone:414-453-7418
Practice Address - Fax:414-453-7420
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI167892086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30887300Medicaid
01204Medicare ID - Type Unspecified
WI30887300Medicaid