Provider Demographics
NPI:1588604367
Name:RAYOS, LYNDA (DO)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:
Last Name:RAYOS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:26901 BEAUMONT BLVD STE 3D
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:947-522-1862
Mailing Address - Fax:947-522-0307
Practice Address - Street 1:27031 W WARREN ST
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-1901
Practice Address - Country:US
Practice Address - Phone:313-274-3320
Practice Address - Fax:313-730-9222
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101013015207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI139934OtherCARE CHOICES
MI0858206445OtherBLUE CROSS
MIC6729OtherMCARE
MIP105062OtherBLUE CROSS
MI4356584Medicaid
MI7414012OtherAETNA
H06092Medicare UPIN
OM89760001Medicare ID - Type Unspecified