Provider Demographics
NPI:1205415890
Name:DUVALL, LYDIA ROSAMOND (DO)
Entity Type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:ROSAMOND
Last Name:DUVALL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3489 FENDER RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:KY
Mailing Address - Zip Code:41059-9455
Mailing Address - Country:US
Mailing Address - Phone:859-448-9174
Mailing Address - Fax:
Practice Address - Street 1:900 N 92ND ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-1202
Practice Address - Country:US
Practice Address - Phone:414-805-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program