Healthcare Provider Details

I. General information

NPI: 1437909199
Provider Name (Legal Business Name): MORGAN DENISE LYTTLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 S 1ST AVE RM 7606
MAYWOOD IL
60153-3328
US

IV. Provider business mailing address

426 BETH DR
MT JULIET TN
37122-2042
US

V. Phone/Fax

Practice location:
  • Phone: 615-268-6074
  • Fax:
Mailing address:
  • Phone: 615-268-6074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1437909199
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: