Provider Demographics
NPI:1982659090
Name:LYON, CAROL K (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:K
Last Name:LYON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1540 LAKE LANSING RD
Mailing Address - Street 2:STE 102
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3707
Mailing Address - Country:US
Mailing Address - Phone:517-913-3810
Mailing Address - Fax:517-913-3811
Practice Address - Street 1:1540 LAKE LANSING RD
Practice Address - Street 2:STE 102
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3707
Practice Address - Country:US
Practice Address - Phone:517-913-3810
Practice Address - Fax:517-913-3811
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2009-10-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301407151207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4123751Medicaid
MI200000002326OtherPHP
MIM21440014OtherMEDICARE ADVANTAGE
MI1001913OtherMCLAREN HEALTH PLAN-COMMERCIAL
MI200000002326OtherPHP FAMILYCARE
MI4096061OtherAETNA
MI1001913OtherMCLAREN HEALTH ADVANTAGE
MI1103301731OtherBCBS/BCN
MI1001913OtherMCLAREN HEALTH PLAN-MEDICAID
MI110205591OtherRAILROAD MEDICARE
MI4848150Medicaid
MIM21440014OtherMEDICARE ADVANTAGE
MI4848150Medicaid