Healthcare Provider Details

I. General information

NPI: 1043839129
Provider Name (Legal Business Name): ALEX LYNCH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2020
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 SAINT ANTOINE ST STE 9C
DETROIT MI
48201-2153
US

IV. Provider business mailing address

4201 SAINT ANTOINE ST STE 9C
DETROIT MI
48201-2153
US

V. Phone/Fax

Practice location:
  • Phone: 313-577-5009
  • Fax: 313-577-5310
Mailing address:
  • Phone: 313-577-5009
  • Fax: 313-577-5310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number346074
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: