Provider Demographics
NPI:1194779983
Name:MCCORMICK, LYNNE MARY (DO)
Entity type:Individual
Prefix:
First Name:LYNNE
Middle Name:MARY
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LYNNE
Other - Middle Name:MARY
Other - Last Name:HINTERBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1011 SUNNYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-8735
Mailing Address - Country:US
Mailing Address - Phone:231-779-2565
Mailing Address - Fax:
Practice Address - Street 1:1011 SUNNYSIDE DR
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-8735
Practice Address - Country:US
Practice Address - Phone:317-792-5652
Practice Address - Fax:231-775-0744
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5599208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M77210Medicare ID - Type Unspecified
F93374Medicare UPIN