MEDICARE: DR. MARYKAY LEHMAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD26132	OR
2	207RP1001X	Pulmonary Disease Physician	MD26132	OR

General Provider Information

NPI Number	:	1003882622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARYKAY LEHMAN M.D.

Provider Business Mailing Address
First Line	:	100 MICHIGAN ST NE
Second Line	:	MC 845
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-2560
Country	:	US
Telephone Number	:	616-486-6790
Fax Number	:

Provider Business Practice Location Address
First Line	:	4100 LAKE DR SE
Second Line	:	SUITE 200
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-8292
Country	:	US
Telephone Number	:	616-949-8244
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	07/08/2022

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