Provider Demographics
NPI:1265693857
Name:DR MICHAEL LYONS PROFFESSIONAL CORPORATION
Entity type:Organization
Organization Name:DR MICHAEL LYONS PROFFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:PROFESSIONAL
Authorized Official - Phone:901-493-5530
Mailing Address - Street 1:1558 MONTEITH AVE
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-7685
Mailing Address - Country:US
Mailing Address - Phone:662-449-3663
Mailing Address - Fax:662-449-3676
Practice Address - Street 1:1558 MONTEITH AVE
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:MS
Practice Address - Zip Code:38632-7685
Practice Address - Country:US
Practice Address - Phone:662-449-3663
Practice Address - Fax:662-449-3676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS80187332B00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS5788670001Medicare NSC