Healthcare Provider Details

I. General information

NPI: 1689672529
Provider Name (Legal Business Name): LYNN LOUISE MATHIA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LYNN LOUISE OZTALAY D.O.

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 12/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37399 GARFIELD RD SUITE 204
CLINTON TWP MI
48036-3672
US

IV. Provider business mailing address

37399 GARFIELD RD SUITE 204
CLINTON TWP MI
48036-3672
US

V. Phone/Fax

Practice location:
  • Phone: 586-421-4204
  • Fax: 586-421-4222
Mailing address:
  • Phone: 586-421-4204
  • Fax: 586-421-4222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number011684
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: