MEDICARE: DR. TAMARA L LYDAY DO

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	207Q00000X	Family Medicine Physician	036121487	IL
2	207Q00000X	Family Medicine Physician	11013444A	IN
3	207Q00000X	Family Medicine Physician	48503	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891903415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAMARA L LYDAY DO

Provider Business Mailing Address
First Line	:	3301 W FOREST HOME AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53215-2843
Country	:	US
Telephone Number	:	414-389-2233
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 PARK RIDGE LN
Second Line	:
City	:	NORTH FOND DU LAC
State	:	WI
Zip	:	54937-1385
Country	:	US
Telephone Number	:	920-926-7800
Fax Number	:	920-496-4705

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

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	07/21/2022

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