Provider Demographics
NPI:1669452496
Name:LYSS, CARL A (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:A
Last Name:LYSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8888 LADUE #210
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124
Mailing Address - Country:US
Mailing Address - Phone:314-290-7455
Mailing Address - Fax:314-725-2651
Practice Address - Street 1:8888 LADUE RD STE 210
Practice Address - Street 2:SUITE 210
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-2056
Practice Address - Country:US
Practice Address - Phone:314-290-7455
Practice Address - Fax:314-725-2651
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2013-04-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO26531207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA12595Medicare UPIN
MOA12598Medicare UPIN
MO002012849Medicare PIN