Individual
JUDY S LYZAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1201 S MAIN ST, ST ANTHONY MEDICAL CENTER, CROWN POINT, IN 46307-8481
(219) 757-6322
(219) 757-5891
Mailing address
113 E 4TH ST, MICHIGAN CITY, IN 46360-3301
(219) 873-3130
(219) 873-3132
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
01045230A
IN
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
036087853
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000646932
ANTHEM BC/BS
IN
01
—
01630255
BC/BS
IL
05
—
200124880A
—
IN
01
—
351173213
HFN
IN
01
—
5197928
CCN
IN
01
—
82432
BC/BS
IN
01
—
8352593005
CIGNA
IN
01
—
P00829245
RAILROAD MEDICARE
IN
Enumeration date
08/25/2005
Last updated
06/30/2011
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