MEDICARE: SARAH LYLE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	29968	WA
2	207QA0000X	Adolescent Medicine (Family Medicine) Physician	29968	WA

General Provider Information

NPI Number	:	1598901621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH LYLE MD

Provider Business Mailing Address
First Line	:	429 MADRONA ST
Second Line	:
City	:	EASTSOUND
State	:	WA
Zip	:	98245-8573
Country	:	US
Telephone Number	:	360-376-7337
Fax Number	:

Provider Business Practice Location Address
First Line	:	429 MADRONA ST
Second Line	:
City	:	EASTSOUND
State	:	WA
Zip	:	98245-8573
Country	:	US
Telephone Number	:	360-376-7337
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2008
Last Update Date	:	12/18/2008

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