Individual
DR. COREY BLAINE LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2750 CLAY EDWARDS DR. STE. 200A, NORTH KANSAS CITY, MO 64116
(816) 968-9320
Mailing address
P.O. BOX 256, LIBERTY, MO 64069-2233
(816) 968-9320
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2005027554
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
207529207
—
MO
01
—
36109027
BCBS OF KC INDIVIDUAL
—
Enumeration date
05/16/2006
Last updated
10/25/2012
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