Provider Demographics
NPI:1568555233
Name:LYLE G VASHER D P M P A
Entity Type:Organization
Organization Name:LYLE G VASHER D P M P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LYLE
Authorized Official - Middle Name:G
Authorized Official - Last Name:VASHER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:941-474-5577
Mailing Address - Street 1:1861 PLACIDA RD.
Mailing Address - Street 2:SUITE# 103
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34223-4911
Mailing Address - Country:US
Mailing Address - Phone:941-474-5577
Mailing Address - Fax:941-473-4145
Practice Address - Street 1:1861 PLACIDA RD.
Practice Address - Street 2:SUITE# 103
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-4911
Practice Address - Country:US
Practice Address - Phone:941-474-5577
Practice Address - Fax:941-473-4145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1478213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL040952900Medicaid
FL1051040001Medicare NSC
FL040952900Medicaid