Individual
RUSSELL LEWIS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
190 GRAND SEASONS DR, WAUPACA, WI 54981-8219
(715) 258-3650
(715) 258-5749
Mailing address
900 ILLINOIS AVENUE, STEVENS POINT, WI 54481
(715) 346-5000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4937420
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34867900
—
WI
Enumeration date
06/24/2006
Last updated
05/27/2008
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