Provider Demographics
NPI:1881688042
Name:LYONS, MICHAEL (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:LYONS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8515 GREENVILLE AVE STE N108
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-7035
Mailing Address - Country:US
Mailing Address - Phone:214-221-0855
Mailing Address - Fax:
Practice Address - Street 1:8515 GREENVILLE AVE STE N108
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-7035
Practice Address - Country:US
Practice Address - Phone:214-221-0855
Practice Address - Fax:214-221-1437
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4316207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080109971OtherRAILROAD MEDICARE
TX4651799OtherAETNA
TX86320KOtherBCBS
TX87671ZOtherHMO BLUE
TX121336501Medicaid
TX87671ZOtherHMO BLUE
TX080109971OtherRAILROAD MEDICARE