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General NPI Number Information
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NPI Number | 1114916350
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Entity Type | Individual
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Provider Name | MICHAEL T LYSTER MD
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Gender | Male
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Dates
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Enumeration Date | 10/20/2005
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Last Update Date | 11/27/2024
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Provider Practice Location Address
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Address Line | 2375 S RIDGEVIEW DR
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City | YUMA
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State | AZ
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Zip | 85364-8868
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Country | US
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Telephone | 928-317-2518
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Fax |
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Provider Business Mailing Address
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Address Line | 2400 S AVENUE A
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City | YUMA
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State | AZ
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Zip | 85364-7127
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Country | US
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Telephone | 928-344-2000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 036081248
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 42959
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License Number State | AZ
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