Healthcare Provider Details

I. General information

NPI: 1194131474
Provider Name (Legal Business Name): DAVID KEVIN LYONS JR. D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2014
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5483 GRATIOT RD
SAGINAW MI
48638-6037
US

IV. Provider business mailing address

5483 GRATIOT RD
SAGINAW MI
48638-6037
US

V. Phone/Fax

Practice location:
  • Phone: 989-583-5626
  • Fax:
Mailing address:
  • Phone: 989-583-5626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number5101025558
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: