Healthcare Provider Details

I. General information

NPI: 1942242078
Provider Name (Legal Business Name): JENNIFER MALLORY LYNCH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1786 MOON LAKE BLVD STE 201
HOFFMAN ESTATES IL
60169-1067
US

IV. Provider business mailing address

3040 W SALT CREEK LN
ARLINGTON HEIGHTS IL
60005-1069
US

V. Phone/Fax

Practice location:
  • Phone: 847-884-7550
  • Fax: 847-884-7510
Mailing address:
  • Phone: 847-870-4780
  • Fax: 847-483-7447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036115293
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: