Provider Demographics
NPI:1215936158
Name:PARLING-LYNCH, KELLY JO (DO)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:JO
Last Name:PARLING-LYNCH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:J
Other - Last Name:LYNCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:5800 FOREMOST DR SE STE 300
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-7062
Mailing Address - Country:US
Mailing Address - Phone:616-954-9800
Mailing Address - Fax:
Practice Address - Street 1:6425 S. HARVEY ST
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49444-9739
Practice Address - Country:US
Practice Address - Phone:231-737-3469
Practice Address - Fax:231-737-4548
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101014119207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1215936158Medicaid
MI4920010Medicaid
MI1215936158Medicaid
MII04317Medicare UPIN
WI37578700Medicaid
MI1215936158Medicaid
WIP00736465Medicare Oscar/Certification
MIM08620064Medicare PIN