Healthcare Provider Details

I. General information

NPI: 1750470647
Provider Name (Legal Business Name): JANE B LYON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 S PINCKNEY ST APT 1123
MADISON WI
53703-3407
US

IV. Provider business mailing address

216 S PINCKNEY ST APT 1123
MADISON WI
53703-3407
US

V. Phone/Fax

Practice location:
  • Phone: 608-287-4198
  • Fax:
Mailing address:
  • Phone: 608-287-4198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number68155-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: