Provider Demographics
NPI:1477546364
Name:LOVING, M LYNN (MD)
Entity Type:Individual
Prefix:
First Name:M
Middle Name:LYNN
Last Name:LOVING
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:PO BOX 78000
Mailing Address - Street 2:DEPT 781267
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:45278-1267
Mailing Address - Country:US
Mailing Address - Phone:937-451-3123
Mailing Address - Fax:937-350-6477
Practice Address - Street 1:5350 LAMME RD
Practice Address - Street 2:
Practice Address - City:MORAINE
Practice Address - State:OH
Practice Address - Zip Code:45439-3215
Practice Address - Country:US
Practice Address - Phone:937-451-3123
Practice Address - Fax:937-350-6477
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-067046207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0776816OtherMEDICARE PTAN
OH0977019Medicaid
OH4094751Medicare PIN
OH0776816OtherMEDICARE PTAN
OH080168100Medicare PIN