# LEWIS JEREMY JOHNSON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1295979474
- **Gender:** Man
- **Credential:** DO

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208600000X | Surgery Physician | 5101017835 | MI | — |
| 208800000X | Urology Physician | 02006859A | IN | Yes |
| 208800000X | Urology Physician | 3622 | KY | — |
| 208800000X | Urology Physician | 5101017835 | MI | — |

## Other

- **Enumeration date:** 05/01/2009
- **Last updated:** 06/30/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1102384432 | ANTHEM PTAN | IN |
| 05 | — | 300066454 | — | IN |