Provider Demographics
NPI:1215980941
Name:LYON, VALERIE B (MD)
Entity type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:B
Last Name:LYON
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:788 N. JEFFERSON STREET
Mailing Address - Street 2:SUITE 300 / ATTN. KAAREN BUTZEN
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-3710
Mailing Address - Country:US
Mailing Address - Phone:414-272-8950
Mailing Address - Fax:414-272-0859
Practice Address - Street 1:375 W RIVER WOODS PKWY
Practice Address - Street 2:SUITE 116
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53212-1080
Practice Address - Country:US
Practice Address - Phone:414-326-1563
Practice Address - Fax:414-326-1589
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI40772207NP0225X, 207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1215980941Medicaid
WI003573645Medicare PIN
WI002646210Medicare PIN