Provider Demographics
NPI:1023231099
Name:LIRA, LINDSEY DANIELLE (MD)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:DANIELLE
Last Name:LIRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27082 W. MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EDWARDSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49112-9334
Mailing Address - Country:US
Mailing Address - Phone:269-246-1375
Mailing Address - Fax:269-246-1376
Practice Address - Street 1:27082 W MAIN ST
Practice Address - Street 2:
Practice Address - City:EDWARDSBURG
Practice Address - State:MI
Practice Address - Zip Code:49112-9334
Practice Address - Country:US
Practice Address - Phone:269-246-1375
Practice Address - Fax:269-246-1376
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01063930A207Q00000X
MI4301103983207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI109836Medicaid
MIP01293890OtherRAILROAD MEDICARE
MIP01293890OtherRAILROAD MEDICARE
MI000000837874OtherANTHEM BCBS
MI000000948871OtherANTHEM BCBS
IN200908490Medicaid
IN200908490Medicaid
MIP01293890OtherRAILROAD MEDICARE
MI000000837874OtherANTHEM BCBS