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Individual
LEWIS JEREMY JOHNSON
Active
Individual
LEWIS JEREMY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
5101017835
MI
208800000X
Urology Physician
Primary
02006859A
IN
208800000X
Urology Physician
3622
KY
208800000X
Urology Physician
5101017835
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1102384432
ANTHEM PTAN
IN
05
—
300066454
—
IN
Enumeration date
05/01/2009
Last updated
06/30/2026
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