Basic Information
| Provider Information | |||||||||
| NPI: | 1164659322 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 60447 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282600447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043848720 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 16525 HOLLY CREST LN STE 150 | ||||||||
| Address2: | |||||||||
| City: | HUNTERSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280784911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043848720 | ||||||||
| FaxNumber: | 7043848747 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2009 | ||||||||
| LastUpdateDate: | 08/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MD034642 | DC | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | N3827 | TX | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 2018-00013 | NC | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 8BQ433 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER |