Provider Demographics
NPI:1053357087
Name:LEWIS, KATHLEEN E (MD)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:E
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1300 MCGEE DR
Mailing Address - Street 2:STE 100
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072
Mailing Address - Country:US
Mailing Address - Phone:405-321-0406
Mailing Address - Fax:405-447-6293
Practice Address - Street 1:1300 MCGEE DR
Practice Address - Street 2:STE 100
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072
Practice Address - Country:US
Practice Address - Phone:405-321-0406
Practice Address - Fax:405-447-6293
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK13223207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100087630AMedicaid
OK100735230BMedicaid
OK100087630AMedicaid