Provider Demographics
NPI:1376586073
Name:LYSON, KRZYSZTOF J (MD)
Entity Type:Individual
Prefix:DR
First Name:KRZYSZTOF
Middle Name:J
Last Name:LYSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:408 W 45TH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-3014
Mailing Address - Country:US
Mailing Address - Phone:512-451-5800
Mailing Address - Fax:512-459-1399
Practice Address - Street 1:4100 DUVAL RD
Practice Address - Street 2:BLDG 4, STE 102
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4277
Practice Address - Country:US
Practice Address - Phone:512-832-0999
Practice Address - Fax:512-832-6094
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8311207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX38224407Medicaid
TX289155YR7HMedicare PIN
G83137Medicare UPIN