Provider Demographics
NPI:1275636425
Name:GREELEY, LYNN L (MC)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:L
Last Name:GREELEY
Suffix:
Gender:F
Credentials:MC
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:L
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3315 N SEMINARY ST
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-1251
Mailing Address - Country:US
Mailing Address - Phone:309-344-1000
Mailing Address - Fax:309-344-1054
Practice Address - Street 1:3315 N SEMINARY ST
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-1251
Practice Address - Country:US
Practice Address - Phone:309-344-1000
Practice Address - Fax:309-344-1054
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36050878208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
4314314OtherAETNA
10588989OtherCAQH
364271985-30OtherJOHN DEERE
4815127OtherBC/BS
IL902600Medicare ID - Type Unspecified
4815127OtherBC/BS
364271985-30OtherJOHN DEERE
ILC37240Medicare UPIN
IL938220Medicare ID - Type Unspecified