Provider Demographics
NPI:1942323423
Name:GYNECOLOGIC CARE W JANICE LYON MDSC
Entity Type:Organization
Organization Name:GYNECOLOGIC CARE W JANICE LYON MDSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:W
Authorized Official - Last Name:LYON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-986-5966
Mailing Address - Street 1:621 PLAINFIELD RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5343
Mailing Address - Country:US
Mailing Address - Phone:630-986-5966
Mailing Address - Fax:630-850-9850
Practice Address - Street 1:621 PLAINFIELD RD
Practice Address - Street 2:SUITE 107
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-5343
Practice Address - Country:US
Practice Address - Phone:630-986-5966
Practice Address - Fax:630-850-9850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036068058174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC51302Medicare UPIN