Healthcare Provider Details

I. General information

NPI: 1811428683
Provider Name (Legal Business Name): MICHAEL ANTHONY LYNCH III DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2017
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 CUMBERLAND AVE
MIDDLESBORO KY
40965-2614
US

IV. Provider business mailing address

3600 CUMBERLAND AVE
MIDDLESBORO KY
40965-2614
US

V. Phone/Fax

Practice location:
  • Phone: 606-242-1100
  • Fax: 606-242-1262
Mailing address:
  • Phone: 606-242-1463
  • Fax: 606-242-1468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR4484
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR4484
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: