Provider Demographics
NPI:1003856667
Name:LYMAN, JOHN L (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:LYMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 HEMPSTEAD STATION DR
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-5164
Mailing Address - Country:US
Mailing Address - Phone:800-875-0136
Mailing Address - Fax:937-619-4381
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:OH
Practice Address - Zip Code:45005-2584
Practice Address - Country:US
Practice Address - Phone:513-312-3656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35046423207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000326508OtherBCBS FOR UVMC
OH000000316956OtherBCBS
OH0536003Medicaid
104734195OtherMICHIGAN MEDICAID
MI104808593Medicaid
OH000000559819OtherANTHEM
OH000000360666OtherBCBS
OH000000377131OtherANTHEM
OH000000493504OtherANTHEM/BCBS
OH000000493504OtherANTHEM/BCBS
MIP53130015Medicare PIN
OH4081348Medicare PIN
IL209235004Medicare PIN
OH000000360666OtherBCBS
OHP00384590Medicare PIN
LY4081344Medicare PIN
LY4081343Medicare PIN
OH000000377131OtherANTHEM
OHP00664326Medicare PIN
OH4212993Medicare PIN
OH000000316956OtherBCBS
OHLY4081346Medicare PIN
OHP00152021Medicare PIN
SCAA34207919Medicare PIN