Provider Demographics
NPI:1417903246
Name:IVANKOVICS, LYNNE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LYNNE
Middle Name:
Last Name:IVANKOVICS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8391 COMMERCE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:COMMERCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-4489
Mailing Address - Country:US
Mailing Address - Phone:248-360-9090
Mailing Address - Fax:248-360-9093
Practice Address - Street 1:8391 COMMERCE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:COMMERCE TWP
Practice Address - State:MI
Practice Address - Zip Code:48382-4489
Practice Address - Country:US
Practice Address - Phone:248-360-9090
Practice Address - Fax:248-360-9093
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003387363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical