Individual
DR. REGGIE DUANE LYELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
313 FEDERAL DR NW, SUITE 200, CORYDON, IN 47112-3070
(812) 738-4155
(812) 738-6104
Mailing address
PO BOX 455, CORYDON, IN 47112-0455
(812) 738-4155
(812) 738-6104
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01042535
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0180571
UNHEALTHCARE
IN
01
—
080062749
MEDICARE RR
IN
05
—
100380200A
—
IN
01
—
1017630001
DMERC
IN
01
—
12044V10062
AHDSH
IN
01
—
338886P
SIHO
IN
01
—
351920057
GROUP TAX ID
IN
01
—
42639
ANTHEM
IN
Enumeration date
06/21/2006
Last updated
12/08/2020
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