Organization
LYLE G. HENRY MD SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LYLE GENE HENRY MD (PRESIDENT)
(414) 961-2120
Entity
Organization
Contact information
Practice address
2015 E NEWPORT AVE STE 305, MILWAUKEE, WI 53211-2949
(414) 961-2120
(414) 961-0335
Mailing address
2015 E NEWPORT AVE STE 305, MILWAUKEE, WI 53211-2949
(414) 961-2120
(414) 961-0335
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
18454
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30888100
—
WI
Enumeration date
07/12/2007
Last updated
07/12/2007
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