MEDICARE: DR. CHRISTIE ANN LYNCH DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	561	FL
2	213ES0103X	Foot & Ankle Surgery Podiatrist	2021035408	MO

General Provider Information

NPI Number	:	1114587490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTIE ANN LYNCH DPM

Provider Business Mailing Address
First Line	:	5139 MATTIS RD STE 102
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128-2250
Country	:	US
Telephone Number	:	314-909-1920
Fax Number	:	314-909-1980

Provider Business Practice Location Address
First Line	:	3824 WATSON RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-1237
Country	:	US
Telephone Number	:	314-352-5436
Fax Number	:	314-352-0749

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2019
Last Update Date	:	09/13/2021

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