1699719021 NPI number — DR. MICHAEL GEORGE LYONS DPM

Table of content: DR. MICHAEL GEORGE LYONS DPM (NPI 1699719021)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699719021 NPI number — DR. MICHAEL GEORGE LYONS DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LYONS
Provider First Name:
MICHAEL
Provider Middle Name:
GEORGE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LYONS
Provider Other First Name:
MICHAEL
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PROFESSIONAL
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1699719021
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/18/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1558 MONTEITH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HERNANDO
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38632-7685
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-449-3663
Provider Business Mailing Address Fax Number:
662-449-3676

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1558 MONTEITH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HERNANDO
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38632-7685
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-449-3663
Provider Business Practice Location Address Fax Number:
662-449-3676
Provider Enumeration Date:
06/15/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  80187 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01353580 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 861168679 . This is a "TAX ID" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".