Individual
DR. HERMAN OSCAR LYLE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6563 WARDS MILL ROAD, MARION, IL 62959-0820
(618) 993-3692
(618) 964-2056
Mailing address
PO BOX 820, MARION, IL 62959-0820
(618) 993-3692
(618) 964-2056
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036-054539
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036076429
BCBS
IL
05
—
036076429
—
IL
01
—
1275530230
RAIL ROAD MEDICARE
IL
Enumeration date
07/06/2005
Last updated
06/04/2008
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