Individual
DR. GIAVONNI MYSTIQUE LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
50 N MEDICAL DR, SALT LAKE CITY, UT 84132-0100
(801) 581-8990
(801) 585-6005
Mailing address
PO BOX 413035, SALT LAKE CITY, UT 84141-3035
(801) 213-3900
(801) 585-3655
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
8365805-1205
UT
2086S0102X
Surgical Critical Care Physician
Primary
8365805-1205
UT
Other
Enumeration date
07/16/2008
Last updated
11/18/2021
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