Provider Demographics
NPI:1184623456
Name:NOORDHOEK, LYLE J (MD)
Entity type:Individual
Prefix:
First Name:LYLE
Middle Name:J
Last Name:NOORDHOEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207A E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-4152
Mailing Address - Country:US
Mailing Address - Phone:785-650-2700
Mailing Address - Fax:785-650-2846
Practice Address - Street 1:207A E 7TH ST
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-4152
Practice Address - Country:US
Practice Address - Phone:785-650-2700
Practice Address - Fax:785-650-2846
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS20508207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSE84243Medicare UPIN
KS057978Medicare ID - Type UnspecifiedPROVIDER NUMBER