Healthcare Provider Details

I. General information

NPI: 1508279910
Provider Name (Legal Business Name): LYNN FRYDRYCH-PIENTAK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LYNN FRYDRYCH

II. Dates (important events)

Enumeration Date: 06/04/2014
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 S NATIONAL AVE
SPRINGFIELD MO
65807-7310
US

IV. Provider business mailing address

PO BOX 7411626
CHICAGO IL
60674-5626
US

V. Phone/Fax

Practice location:
  • Phone: 417-875-3246
  • Fax: 417-875-3810
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number162004
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD480968
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4301104772
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number2024011403
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: