Provider Demographics
NPI:1508168139
Name:LYMAN ORTHOPEDICS PLLC
Entity Type:Organization
Organization Name:LYMAN ORTHOPEDICS PLLC
Other - Org Name:THE LYMAN KNEE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KERSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-758-0719
Mailing Address - Street 1:1875 N LAKEWOOD DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-4928
Mailing Address - Country:US
Mailing Address - Phone:208-758-0716
Mailing Address - Fax:208-667-7717
Practice Address - Street 1:1875 N LAKEWOOD DR
Practice Address - Street 2:SUITE 200
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4928
Practice Address - Country:US
Practice Address - Phone:208-758-0716
Practice Address - Fax:208-667-7717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM10680207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty