Provider Demographics
NPI:1093777427
Name:BEARD, LYLE E (MD)
Entity Type:Individual
Prefix:MR
First Name:LYLE
Middle Name:E
Last Name:BEARD
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:PO BOX 950238
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0238
Mailing Address - Country:US
Mailing Address - Phone:812-949-5077
Mailing Address - Fax:812-949-5073
Practice Address - Street 1:3589 LAFAYETTE PKWY
Practice Address - Street 2:
Practice Address - City:FLOYDS KNOBS
Practice Address - State:IN
Practice Address - Zip Code:47119-9760
Practice Address - Country:US
Practice Address - Phone:812-949-6264
Practice Address - Fax:812-949-5073
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01033730A207R00000X, 208M00000X
KY24109207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100086780BMedicaid
KY64241094Medicaid
KY09777101Medicare ID - Type Unspecified
IN231210Medicare ID - Type Unspecified
KY64241094Medicaid