Provider Demographics
NPI:1821038720
Name:LYNCH, KATHERINE D (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:D
Last Name:LYNCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4201 WINFIELD RD FL 4
Mailing Address - Street 2:CENTRALIZED SERVICES
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555
Mailing Address - Country:US
Mailing Address - Phone:331-221-6377
Mailing Address - Fax:331-221-2357
Practice Address - Street 1:1100 LAKE ST STE 230
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1095
Practice Address - Country:US
Practice Address - Phone:331-221-9001
Practice Address - Fax:331-221-2759
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2021-04-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036089584207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036089584Medicaid
ILK02865Medicare ID - Type Unspecified
IL036089584Medicaid