Individual
KEVAN G LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3059 VOYAGER DR, GREEN BAY, WI 54311-8303
(920) 965-0345
(920) 257-4559
Mailing address
2221 S WEBSTER AVE, STE 241, GREEN BAY, WI 54301-2158
(920) 965-0345
(920) 273-6011
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
51745
MN
207N00000X
Dermatology Physician
53110-20
WI
207N00000X
Dermatology Physician
LP00514
RI
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
53110-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1497970560
—
WI
01
—
53110-020
STATE LICENSE
WI
05
—
ENROLLED
—
IA
05
—
ENROLLED
—
MN
01
—
P00787809
RAILROAD MEDICARE
MN
Enumeration date
04/16/2007
Last updated
03/07/2023
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