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General NPI Number Information
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NPI Number | 1689672529
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Entity Type | Individual
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Provider Name | LYNN LOUISE MATHIA D.O.
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Gender | Female
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Dates
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Enumeration Date | 07/13/2005
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Last Update Date | 12/09/2009
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Provider Practice Location Address
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Address Line | 37399 GARFIELD RD SUITE 204
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City | CLINTON TWP
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State | MI
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Zip | 48036-3672
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Country | US
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Telephone | 586-421-4204
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Fax | 586-421-4222
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Provider Business Mailing Address
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Address Line | 37399 GARFIELD RD SUITE 204
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City | CLINTON TWP
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State | MI
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Zip | 48036-3672
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Country | US
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Telephone | 586-421-4204
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Fax | 586-421-4222
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 011684
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License Number State | MI
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