Provider Demographics
NPI:1275524175
Name:VALENTIJN, LYNNETTE M (MD)
Entity type:Individual
Prefix:
First Name:LYNNETTE
Middle Name:M
Last Name:VALENTIJN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4684 WENMAR DR
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-2817
Mailing Address - Country:US
Mailing Address - Phone:989-793-1095
Mailing Address - Fax:
Practice Address - Street 1:4684 WENMAR DR
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2817
Practice Address - Country:US
Practice Address - Phone:989-793-1095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301406348208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100260460Medicaid
IN000000869274OtherBCBS BMG PEDIATRICS BRISTOL ST
IN000000869274OtherBCBS BMG PEDIATRICS BRISTOL ST