Individual
DR. LYLE GENE HENRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2350 N LAKE DR, SUITE 304, MILWAUKEE, WI 53211-4528
(414) 298-7220
(414) 298-7229
Mailing address
788 N JEFFERSON ST, SUITE 300/ATTN KAAREN BUTZEN, MILWAUKEE, WI 53202-3718
(414) 272-8950
(414) 272-0859
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
18454
WI
2086S0129X
Vascular Surgery Physician
18454
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1043242035
—
WI
Enumeration date
07/07/2006
Last updated
02/25/2013
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