Provider Demographics
NPI:1649277658
Name:LYNOTT, JAMES V (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:V
Last Name:LYNOTT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-663-9009
Practice Address - Street 1:1300 S GREEN BAY RD STE 100
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-4469
Practice Address - Country:US
Practice Address - Phone:262-619-4191
Practice Address - Fax:262-634-5185
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2024-12-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI46939207ND0101X
WI46939-20207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIH54218Medicare UPIN
WI321250009Medicare ID - Type Unspecified
WIWI2022005Medicare PIN