Healthcare Provider Details

I. General information

NPI: 1356303242
Provider Name (Legal Business Name): JOHN A LYNCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 COON RAPIDS BLVD NW
COON RAPIDS MN
55433-2522
US

IV. Provider business mailing address

1055 WESTGATE DR STE 100
SAINT PAUL MN
55114-1451
US

V. Phone/Fax

Practice location:
  • Phone: 651-635-9173
  • Fax:
Mailing address:
  • Phone: 651-635-9173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number28548
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number28548
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: