Healthcare Provider Details

I. General information

NPI: 1194779983
Provider Name (Legal Business Name): LYNNE MARY MCCORMICK DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LYNNE MARY HINTERBERG

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S EAST AVE
JACKSON MI
49201-2412
US

IV. Provider business mailing address

1011 SUNNYSIDE DR
CADILLAC MI
49601-8735
US

V. Phone/Fax

Practice location:
  • Phone: 517-205-2146
  • Fax:
Mailing address:
  • Phone: 231-779-2565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number5101011781
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number5599
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: