Healthcare Provider Details

I. General information

NPI: 1598729220
Provider Name (Legal Business Name): LYLE JAMES DENNIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 9TH ST N STE 110
NAPLES FL
34102-5886
US

IV. Provider business mailing address

311 9TH ST N STE 110
NAPLES FL
34102-5886
US

V. Phone/Fax

Practice location:
  • Phone: 239-624-4286
  • Fax: 239-624-4201
Mailing address:
  • Phone: 239-624-4286
  • Fax: 239-624-4201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number77788
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMA07078200
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number205562
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number0101276333
License Number StateVA
# 5
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME161670
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: