Provider Demographics
NPI:1275508053
Name:EGYED, LYNDELLE MARIE (PA)
Entity Type:Individual
Prefix:
First Name:LYNDELLE
Middle Name:MARIE
Last Name:EGYED
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 S HEALTH PKWY
Mailing Address - Street 2:MEDICAL STAFF OFFICE
Mailing Address - City:THREE RIVERS
Mailing Address - State:MI
Mailing Address - Zip Code:49093-8352
Mailing Address - Country:US
Mailing Address - Phone:269-273-9789
Mailing Address - Fax:269-273-9611
Practice Address - Street 1:601 E CHICAGO RD
Practice Address - Street 2:
Practice Address - City:WHITE PIGEON
Practice Address - State:MI
Practice Address - Zip Code:49099-9731
Practice Address - Country:US
Practice Address - Phone:269-483-7624
Practice Address - Fax:269-483-7905
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002567363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3070626-11Medicaid
MI700G560080OtherBCBS GROUP-THREE RIVERS HEALTH
MI700G560080OtherBCBS GROUP-THREE RIVERS HEALTH
MI230015Medicare Oscar/Certification
MI238506Medicare Oscar/Certification