Provider Demographics
NPI:1659589653
Name:LYNCH, MATTHEW LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:LAWRENCE
Last Name:LYNCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:26900 N LAKE PLEASANT PKWY
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-1558
Mailing Address - Country:US
Mailing Address - Phone:623-524-8960
Mailing Address - Fax:623-524-8959
Practice Address - Street 1:26900 N LAKE PLEASANT PKWY
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-1558
Practice Address - Country:US
Practice Address - Phone:623-524-8960
Practice Address - Fax:623-524-8959
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036114509208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34940200Medicaid
WI003513135Medicare PIN