Individual
LYLE PRAIRIE
Active
Individual
LYLE PRAIRIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
206263
NY
207L00000X
Anesthesiology Physician
Primary
206263-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01753906
—
NY
01
—
0645
EXCELLUS BC/BS
NY
01
—
103217AF
PREFERRED CARE
NY
01
—
AN206263-6
WORKERS' COMPENSATION
NY
01
—
P010203263
EXCELLUS BLUE CHOICE
NY
Enumeration date
06/16/2006
Last updated
06/16/2025
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