Healthcare Provider Details

I. General information

NPI: 1508832155
Provider Name (Legal Business Name): DAVID E LYON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 10/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 N STATE ST
STANTON MI
48888-9702
US

IV. Provider business mailing address

611 N STATE ST
STANTON MI
48888-9702
US

V. Phone/Fax

Practice location:
  • Phone: 989-584-3131
  • Fax: 989-584-6734
Mailing address:
  • Phone: 989-584-3131
  • Fax: 989-584-6734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number5101014171
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: