Provider Demographics
NPI:1598864233
Name:LYNCH, JULIE R (DO)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:R
Last Name:LYNCH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:JULIE
Other - Middle Name:R
Other - Last Name:OSBORNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:14780 W MOUNTAIN VIEW BLVD
Mailing Address - Street 2:STE 110
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-7280
Mailing Address - Country:US
Mailing Address - Phone:262-740-0900
Mailing Address - Fax:262-740-0909
Practice Address - Street 1:312 S 7TH ST
Practice Address - Street 2:SUITE 4
Practice Address - City:DELAVAN
Practice Address - State:WI
Practice Address - Zip Code:53115-1964
Practice Address - Country:US
Practice Address - Phone:262-740-0900
Practice Address - Fax:262-740-0909
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI44907-021207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIH82688Medicare UPIN
WIH82688Medicare UPIN