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General NPI Number Information
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NPI Number | 1942323423
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Entity Type | Organization
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Legal Business Name | GYNECOLOGIC CARE W JANICE LYON MDSC
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Dates
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Enumeration Date | 04/09/2007
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Last Update Date | 11/19/2012
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Provider Practice Location Address
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Address Line | 621 PLAINFIELD RD SUITE 107
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City | WILLOWBROOK
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State | IL
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Zip | 60527-5343
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Country | US
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Telephone | 630-986-5966
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Fax | 630-850-9850
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Provider Business Mailing Address
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Address Line | 621 PLAINFIELD RD SUITE 107
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City | WILLOWBROOK
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State | IL
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Zip | 60527-5343
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Country | US
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Telephone | 630-986-5966
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Fax | 630-850-9850
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Authorized Official
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Title or Position | OWNER
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Name | DR. JANICE W LYON
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Credential | M.D.
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Telephone | 630-986-5966
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 036068058
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License Number State | IL
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