Provider Demographics
NPI:1144327446
Name:LEWIS, BEVERLY RENEE (MD)
Entity type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:RENEE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:333 WASHINGTON AVENUE NORTH
Mailing Address - Street 2:318 UNION PLAZA
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55401-1367
Mailing Address - Country:US
Mailing Address - Phone:612-349-2797
Mailing Address - Fax:612-349-2760
Practice Address - Street 1:333 WASHINGTON AVENUE NORTH
Practice Address - Street 2:318 UNION PLAZA
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55401-1367
Practice Address - Country:US
Practice Address - Phone:612-349-2797
Practice Address - Fax:612-349-2760
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN407442084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNG76467Medicare UPIN