MEDICARE: DR. LYLE DEAN HASKELL DPM

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	213E00000X	Podiatrist	0979	TX

General Provider Information

NPI Number	:	1609825207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LYLE DEAN HASKELL DPM

Provider Business Mailing Address
First Line	:	1105 CENTRAL EXPY N
Second Line	:	SUITE 220
City	:	ALLEN
State	:	TX
Zip	:	75013-6103
Country	:	US
Telephone Number	:	972-727-7060
Fax Number	:	972-727-0080

Provider Business Practice Location Address
First Line	:	5941 DALLAS PKWY STE 100
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-9002
Country	:	US
Telephone Number	:	972-758-4455
Fax Number	:	972-812-4196

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

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	10/18/2024

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