MEDICARE: MRS. TONYA LASHAWN LYNCH ULTRASONOGRAPHER

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	2471S1302X	Sonography Radiologic Technologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1616020	OTHER	IL	BC/BS

General Provider Information

NPI Number	:	1306949870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TONYA LASHAWN LYNCH ULTRASONOGRAPHER

Provider Business Mailing Address
First Line	:	3690 W 71ST AVENUE
Second Line	:
City	:	MERRILLVILLE
State	:	IN
Zip	:	46410
Country	:	US
Telephone Number	:	219-985-1381
Fax Number	:

Provider Business Practice Location Address
First Line	:	1725 W HARRISON ST
Second Line	:	SUITE 408
City	:	CHICAGO
State	:	IL
Zip	:	60612
Country	:	US
Telephone Number	:	312-997-2229
Fax Number	:

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

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	07/08/2007

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