Individual
MATTHEW A LYLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AA
Contact information
Practice address
36500 AURORA DR, SUMMIT, WI 53066-4899
(262) 434-1000
(262) 434-5050
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
102
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100072575
—
WI
05
—
1730634817
—
WI
Enumeration date
08/18/2016
Last updated
03/26/2025
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