Provider Demographics
NPI:1821139429
Name:LYNCH, MICHAEL JAMES (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JAMES
Last Name:LYNCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N8985 S SHORE LN
Mailing Address - Street 2:
Mailing Address - City:DEERBROOK
Mailing Address - State:WI
Mailing Address - Zip Code:54424-9657
Mailing Address - Country:US
Mailing Address - Phone:715-610-5049
Mailing Address - Fax:
Practice Address - Street 1:N8985 S SHORE LN
Practice Address - Street 2:
Practice Address - City:DEERBROOK
Practice Address - State:WI
Practice Address - Zip Code:54424-9657
Practice Address - Country:US
Practice Address - Phone:715-610-5049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI24081207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine