Provider Demographics
NPI:1902854102
Name:ASHBERG, LYALL J (MD)
Entity type:Individual
Prefix:DR
First Name:LYALL
Middle Name:J
Last Name:ASHBERG
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:116 BUTTONBUSH DR
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7734
Mailing Address - Country:US
Mailing Address - Phone:630-796-9928
Mailing Address - Fax:561-437-8337
Practice Address - Street 1:116 BUTTONBUSH DR
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7734
Practice Address - Country:US
Practice Address - Phone:630-796-9928
Practice Address - Fax:561-437-8337
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036139327207X00000X
FLME84409207XP3100X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263685900Medicaid
ILPENDINGMedicare PIN
I17399Medicare UPIN
FL263685900Medicaid