Basic Information
| Provider Information | |||||||||
| NPI: | 1225094246 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEWAN | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1707 COLE BLVD. | ||||||||
| Address2: | STE #100 | ||||||||
| City: | GOLDEN | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037168018 | ||||||||
| FaxNumber: | 3037635495 | ||||||||
| Practice Location | |||||||||
| Address1: | 12169 SHERIDAN BLVD | ||||||||
| Address2: | |||||||||
| City: | BROOMFIELD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800202459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036039400 | ||||||||
| FaxNumber: | 3036039420 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 05/26/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 39800 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 98174363 | 05 | CO | MEDICAID |