Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 71560 | WI |
NPI | 1003255530 |
---|---|
Provider Name | Dr. Jeffrey T Lyvers |
First Address | Milwaukee, WI 53215-2843 |
Second Address | Milwaukee, WI 53215-4330 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2013 |
Last Update Date | 19/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100092052 | (05) | WI |