KEVAN G LEWIS (NPI# 1497970560) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497970560 |
| Entity Type | Individual |
| Full Name | KEVAN G LEWIS |
| Credential | MD |
| Practice Address |
3059 Voyager Dr Green Bay WI 54311-8303 |
| Mailing Address |
2221 S Webster Ave Ste 241 Green Bay WI 54301-2158 |
| Practice Telephone | 9209650345 |
| Practice Fax Number | 9202574559 |
| Mailing Telephone | 9209650345 |
| Mailing Fax Number | 9202736011 |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2020-09-29 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207N00000X | Dermatology | 53110-20 | WI | Allopathic & Osteopathic Physicians |
| N | 207N00000X | Dermatology | 51745 | MN | Allopathic & Osteopathic Physicians |
| N | 207N00000X | Dermatology | LP00514 | RI | Allopathic & Osteopathic Physicians |
| Y | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
53110-020 | WI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | STATE LICENSE | 53110-020 | 01 |
| IA | ENROLLED | 05 | |
| MN | RAILROAD MEDICARE | P00787809 | 01 |
| MN | ENROLLED | 05 | |
| WI | 1497970560 | 05 | |
| WI | DEA | FL0601179 | 01 |
| Street Address |
3059 VOYAGER DR |
| City | GREEN BAY |
| State | WI |
| Zip Code | 54311-8303 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427670520 | Matthew Alan Rand | Physician Assistant | 3059 Voyager Dr, Green Bay, WI 54311-8303 | 2020-05-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295333847 | Karen Ginnow | Pharmacist | Walmart #1908, 2292 Main St, Green Bay, WI 54311 | 2020-10-15 |
| 1639786551 | Maggie Hall | Dental Hygienist | 2633 Development Dr. Ste 40, Green Bay, WI 54311 | 2020-09-24 |
| 1295370807 | Jennifer Marie Arendt | Technician | 2970 Mossy Oak Cir #39, Green Bay, WI 54311 | 2019-11-07 |
| 1518508803 | Cheryl Ann Johnson | Specialist | 830 Edgewood Dr., Green Bay, WI 54311 | 2019-10-08 |
| 1124670898 | Robert H Wagner Family Dentist S.c. | Dentist | 2830 Curry Court, Suite 1, Green Bay, WI 54311 | 2019-07-12 |
| 1821659624 | The Salvation Army | Counselor | The Salvation Army Ray & Joan Kroc Center, 1315 Lime Kiln Road, Green Bay, WI 54311 | 2019-06-24 |
| 1578052866 | Matthew Robert Wagner | Dentist | 2830 Curry Ln #1, Green Bay, WI 54311 | 2018-05-02 |
| 1861916769 | Atlas Spinal Care | Chiropractor | 2069 Central Ct, Suite 11, Green Bay, WI 54311 | 2017-08-01 |
| 1851844161 | Green Bay Family Dental LLC | Dentist | 2609 Development Dr., Green Bay, WI 54311 | 2016-08-03 |
| 1710382809 | Betsy Hoida | Pharmacist | 2485 Greenbrier Rd., Green Bay, WI 54311 | 2014-10-31 |
| Find all providers in zip 54311 | ||||
| Taxonomy Code | 207ND0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| Specialization | MOHS-Micrographic Surgery |
| The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S. |
| Notes: Source: American College of Mohs Surgery, 2007 [1/1/2008: added definition, added source] Additional Resources: Additional Resources: http://www.mohscollege.org/; American Board of Dermatology, 2007. http://www.abderm.org/ |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013350958 | New Dermatology Group Ltd | Dermatology | 704 S Webster Ave, Green Bay, WI 54301-3528 | 2013-04-10 |
| 1356784334 | New Dermatology Group Ltd | Dermatology | 1747 Shawano Ave, Green Bay, WI 54303-3243 | 2013-04-09 |
| 1235480112 | New Dermatology Group Ltd | Dermatology | 2021 S Webster Ave, Green Bay, WI 54301-2257 | 2012-10-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922605880 | Forefront Dermatology Sc | Dermatology | W7713 Johnson Ct, Wautoma, WI 54982-5274 | 2020-10-05 |
| 1023482569 | Forefront Dermatology, S.c. | Dermatology | 1320 Pabst Farms Cir, Suite 180, Oconomowoc, WI 53066 | 2015-11-20 |
| 1417105545 | Forefront Dermatology, S.c. | Dermatology | 3515 Murray Street, Marinette, WI 54143 | 2008-09-03 |
| 1588857247 | Forefront Dermatology, S.c. | Dermatology | 1400 Scheuring Road, De Pere, WI 54115 | 2007-08-24 |
| 1083768253 | Forefront Dermatology, S.c. | Dermatology | 3935 N Lightning Dr, Appleton, WI 54913 | 2007-01-23 |
| 1003356692 | Forefront Dermatology, S.c. | Dermatology | 17100 W North Ave, Suite 200, Brookfield, WI 53005 | 2017-03-01 |
| 1477001956 | Forefront Dermatology, S.c. | Dermatology | 8501 75th St, Suite J, Kenosha, WI 53142 | 2016-09-14 |
| 1215483201 | Forefront Dermatology, S.c. | Dermatology | 10500 W Loomis Rd, Suite 110, Franklin, WI 53132 | 2016-08-30 |
| 1275913006 | Maxim Alexandrovich Polansky | Dermatology | 1000 N Oak Ave, Marshfield, WI 54449-5703 | 2015-06-06 |
| 1285972836 | Forefront Dermatology, S.c. | Dermatology | 1610 Maxwell Dr, Suite 210, Hudson, WI 54016 | 2013-01-16 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.