Provider Demographics
NPI:1245330729
Name:LYON, JOHN H (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:H
Last Name:LYON
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 1:1550 N NORTHWEST HWY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1411
Mailing Address - Country:US
Mailing Address - Phone:847-298-7024
Mailing Address - Fax:847-298-7155
Practice Address - Street 1:1550 N NORTHWEST HWY
Practice Address - Street 2:SUITE 220
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1411
Practice Address - Country:US
Practice Address - Phone:847-824-3198
Practice Address - Fax:847-824-1291
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036096443207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036096443Medicaid
IL201217OtherPTAN LOCALITY 15
IL604530Medicare PIN
ILK05540Medicare ID - Type UnspecifiedFOX RIVER GROVE LOCATION
ILH50184Medicare UPIN
ILK05539Medicare ID - Type UnspecifiedDES PLAINES LOCATION
IL036096443Medicaid