Provider Demographics
NPI:1467444661
Name:LYON, SUSAN THAYER (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:THAYER
Last Name:LYON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7350 W COLLEGE DR
Mailing Address - Street 2:STUITE 208
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1189
Mailing Address - Country:US
Mailing Address - Phone:708-361-9199
Mailing Address - Fax:708-361-9299
Practice Address - Street 1:7350 W COLLEGE DR
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1189
Practice Address - Country:US
Practice Address - Phone:708-361-9199
Practice Address - Fax:708-361-9299
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK22614Medicare PIN
ILD15810Medicare UPIN