Healthcare Provider Details

I. General information

NPI: 1699879130
Provider Name (Legal Business Name): JAMES LYNCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 03/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3389 CLEARBROOK GRN
SAUGATUCK MI
49453-9426
US

IV. Provider business mailing address

PO BOX 340
SAUGATUCK MI
49453-0340
US

V. Phone/Fax

Practice location:
  • Phone: 269-857-5614
  • Fax:
Mailing address:
  • Phone: 269-857-5614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301030163
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: