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Organization
KENNETH M. LYSSY JR MD PA
Active
Organization
KENNETH M. LYSSY JR MD PA
Active
Other names
Dr Kenneth M Lyssy Jr MD
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MELISSA SOUHRADA (OFFICE MANAGER)
(210) 256-9500
Entity
Organization
Contact information
Practice address
6100 BANDERA RD, SUITE 403, SAN ANTONIO, TX 78238-1652
(210) 256-9500
(210) 256-8720
Mailing address
6100 BANDERA, # 403, SAN ANTONIO, TX 78238-1653
(210) 256-9500
(210) 256-8720
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00Z062
MEDICARE INDIVIDUAL PTAN
TX
Enumeration date
06/06/2007
Last updated
07/02/2008
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