Provider Demographics
NPI:1184697906
Name:LEWIS, TRACY M (MD)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:M
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:N17W24100 RIVERWOOD DR STE 250
Mailing Address - Street 2:PROHEALTH CARE MEDICAL ASSOCIATES INC.
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1177
Mailing Address - Country:US
Mailing Address - Phone:262-928-4100
Mailing Address - Fax:
Practice Address - Street 1:2130 BIG BEND RD
Practice Address - Street 2:PROHEALTH CARE MEDICAL ASSOCIATES INC.
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53189-7624
Practice Address - Country:US
Practice Address - Phone:262-928-7555
Practice Address - Fax:262-513-7575
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2011-11-15
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Provider Licenses
StateLicense IDTaxonomies
WI40192207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32635000Medicaid
WI32635000Medicaid
WIH12337Medicare UPIN