Individual
TOD C LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1346 E GREEN BAY ST, SHAWANO, WI 54166-2210
(715) 526-6244
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
32856
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31955600
—
WI
Enumeration date
06/26/2006
Last updated
07/05/2024
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