Basic Information
Provider Information
NPI: 1417061185
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LEWIS
FirstName: KARA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
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Mailing Information
Address1: 3200 E CAMELBACK RD STE 250
Address2:  
City: PHOENIX
State: AZ
PostalCode: 850182327
CountryCode: US
TelephoneNumber: 6029331814
FaxNumber: 6029331820
Practice Location
Address1: 1919 E THOMAS RD
Address2: AMBULATORY BUILDING
City: PHOENIX
State: AZ
PostalCode: 850167710
CountryCode: US
TelephoneNumber: 6029330970
FaxNumber: 6029334253
Other Information
ProviderEnumerationDate: 08/18/2006
LastUpdateDate: 01/17/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084N0402X22835AZY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology

No ID Information.


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