Healthcare Provider Details

I. General information

NPI: 1205760626
Provider Name (Legal Business Name): MR. LYNN BLAND III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 PORTAGE ST
KALAMAZOO MI
49001-3836
US

IV. Provider business mailing address

69 MERRITT ST
BATTLE CREEK MI
49017-4807
US

V. Phone/Fax

Practice location:
  • Phone: 269-373-6000
  • Fax:
Mailing address:
  • Phone: 269-830-2511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: