Provider Demographics
NPI:1043251648
Name:LYNCH, JOHN ROBORG (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ROBORG
Last Name:LYNCH
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Gender:M
Credentials:MD
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Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:DEPARTMENT OF NEUROLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-9236
Mailing Address - Fax:414-805-5252
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:DEPARTMENT OF NEUROLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-9236
Practice Address - Fax:414-805-5252
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2022-07-01
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Provider Licenses
StateLicense IDTaxonomies
WI492542084N0400X
MT1040552084N0400X
FLME1569912084N0400X
SD131362084N0400X
MIEMC00015122084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1043251648Medicaid
WI1043251648Medicaid
WI680862532Medicare PIN
H61876Medicare UPIN