Provider Demographics
NPI:1568545960
Name:DESOTEL, LYNNE JANINE (MD)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:JANINE
Last Name:DESOTEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LYNNE
Other - Middle Name:JANINE
Other - Last Name:WITTHOPF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1215 DUFF AVE
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-5469
Mailing Address - Country:US
Mailing Address - Phone:515-239-4400
Mailing Address - Fax:
Practice Address - Street 1:421 E MERLE HIBBS BLVD
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-0000
Practice Address - Country:US
Practice Address - Phone:641-752-5469
Practice Address - Fax:641-844-2205
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA37123207Q00000X
WI48790-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WII47886Medicare UPIN