Provider Demographics
NPI:1508832155
Name:LYON, DAVID E (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:E
Last Name:LYON
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:611 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48888-9702
Mailing Address - Country:US
Mailing Address - Phone:989-584-3131
Mailing Address - Fax:989-584-6734
Practice Address - Street 1:611 N STATE ST
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:MI
Practice Address - Zip Code:48888-9702
Practice Address - Country:US
Practice Address - Phone:989-584-3131
Practice Address - Fax:989-584-6734
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI51010141712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE96012013Medicare PIN
H23052Medicare UPIN