Provider Demographics
NPI:1477548782
Name:LYNCH, DANIEL JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JOSEPH
Last Name:LYNCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1850 W WINCHESTER RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-5355
Mailing Address - Country:US
Mailing Address - Phone:847-362-9050
Mailing Address - Fax:847-362-9486
Practice Address - Street 1:1850 W WINCHESTER RD
Practice Address - Street 2:SUITE 220
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5355
Practice Address - Country:US
Practice Address - Phone:847-362-9050
Practice Address - Fax:847-362-9486
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036077341207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036077341Medicaid
IL364408211OtherFEIN
IL036077341Medicaid
IL364408211OtherFEIN