MEDICARE: DR. LYNN LOUISE MATHIA D.O.

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	011684	MI

General Provider Information

NPI Number	:	1689672529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LYNN LOUISE MATHIA D.O.

Provider Business Mailing Address
First Line	:	37399 GARFIELD RD
Second Line	:	SUITE 204
City	:	CLINTON TWP
State	:	MI
Zip	:	48036-3672
Country	:	US
Telephone Number	:	586-421-4204
Fax Number	:	586-421-4222

Provider Business Practice Location Address
First Line	:	37399 GARFIELD RD
Second Line	:	SUITE 204
City	:	CLINTON TWP
State	:	MI
Zip	:	48036-3672
Country	:	US
Telephone Number	:	586-421-4204
Fax Number	:	586-421-4222

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	12/09/2009

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