Healthcare Provider Details

I. General information

NPI: 1831122811
Provider Name (Legal Business Name): GEORGE D LYLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 E LAKE HOWARD DR
WINTER HAVEN FL
33881-3155
US

IV. Provider business mailing address

8181 NW 154TH ST STE 200
MIAMI LAKES FL
33016-5861
US

V. Phone/Fax

Practice location:
  • Phone: 863-299-1251
  • Fax: 863-299-7666
Mailing address:
  • Phone: 305-558-3724
  • Fax: 786-907-4485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License NumberME64521
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberME64521
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberME64521
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: