Provider Demographics
NPI:1609825207
Name:HASKELL, LYLE DEAN (DPM)
Entity type:Individual
Prefix:DR
First Name:LYLE
Middle Name:DEAN
Last Name:HASKELL
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:1105 CENTRAL EXPY N
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-6103
Mailing Address - Country:US
Mailing Address - Phone:972-727-7060
Mailing Address - Fax:972-727-0080
Practice Address - Street 1:5941 DALLAS PKWY STE 100
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-9002
Practice Address - Country:US
Practice Address - Phone:972-758-4455
Practice Address - Fax:972-812-4196
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2024-10-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX0979213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T13730Medicare UPIN
8F4685Medicare PIN
87V980Medicare ID - Type Unspecified
TX6238030001Medicare NSC