Provider Demographics
NPI:1689672529
Name:MATHIA, LYNN LOUISE (DO)
Entity type:Individual
Prefix:DR
First Name:LYNN
Middle Name:LOUISE
Last Name:MATHIA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:LOUISE
Other - Last Name:OZTALAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:37399 GARFIELD RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-3672
Mailing Address - Country:US
Mailing Address - Phone:586-421-4204
Mailing Address - Fax:586-421-4222
Practice Address - Street 1:37399 GARFIELD RD
Practice Address - Street 2:SUITE 204
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48036-3672
Practice Address - Country:US
Practice Address - Phone:586-421-4204
Practice Address - Fax:586-421-4222
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI011684208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery