Provider Demographics
NPI:1811012503
Name:LYLE D HASKELL
Entity Type:Organization
Organization Name:LYLE D HASKELL
Other - Org Name:NORTH TEXAS FOOT GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:HASKELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:972-727-7060
Mailing Address - Street 1:1105 CENTRAL EXPY N
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-6103
Mailing Address - Country:US
Mailing Address - Phone:972-727-7060
Mailing Address - Fax:972-727-0080
Practice Address - Street 1:1105 CENTRAL EXPY N
Practice Address - Street 2:SUITE 220
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-6103
Practice Address - Country:US
Practice Address - Phone:972-727-7060
Practice Address - Fax:972-727-0080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0979213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT13730Medicare UPIN
00X402Medicare PIN