Healthcare Provider Details

I. General information

NPI: 1033126008
Provider Name (Legal Business Name): LYNN RAE MERSHON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LYNN RAE DECKER DO

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 LARKIN AVE SUITE 3
ELGIN IL
60123
US

IV. Provider business mailing address

1990 LARKIN AVE SUITE 3
ELGIN IL
60123
US

V. Phone/Fax

Practice location:
  • Phone: 847-289-5727
  • Fax: 847-888-5469
Mailing address:
  • Phone: 847-289-5727
  • Fax: 847-888-5469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: