Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4301079780 | MI |
N | 111NI0900X | Internist | 4301079780 | MI |
N | 207RH0003X | Hematology & Oncology | 4301079780 | MI |
Y | 207RX0202X | Medical Oncology | 4301079780 | MI |
NPI | 1104902063 |
---|---|
Provider Name | Susan Elizabeth Lyons |
First Address | Southfield, MI 48075-3707 |
Second Address | Southfield, MI 48075-3707 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 27/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
105191003 | (05) | MI |
H71920 | (02) | MI |