MEDICARE: LISA M FLYNN MD

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	208600000X	Surgery Physician	4301061622	MI
2	2086S0129X	Vascular Surgery Physician	4301061622	MI

General Provider Information

NPI Number	:	1629070271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA M FLYNN MD

Provider Business Mailing Address
First Line	:	1420 STEPHENSON HWY
Second Line	:	SUITE 400-CREDENTIALING
City	:	TROY
State	:	MI
Zip	:	48083-1189
Country	:	US
Telephone Number	:	248-581-5974
Fax Number	:	248-581-5640

Provider Business Practice Location Address
First Line	:	4160 JOHN R
Second Line	:	SUITE 615
City	:	DETROIT
State	:	MI
Zip	:	48201-2020
Country	:	US
Telephone Number	:	313-745-4195
Fax Number	:	313-993-8669

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

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	12/27/2013

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Directions to “ LISA M FLYNN MD” Practice Location

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