Provider Demographics
NPI:1285958223
Name:LYNCH, BRODI KATELYN (MD)
Entity type:Individual
Prefix:DR
First Name:BRODI
Middle Name:KATELYN
Last Name:LYNCH
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 1:805 W CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:STANDISH
Mailing Address - State:MI
Mailing Address - Zip Code:48658-9526
Mailing Address - Country:US
Mailing Address - Phone:989-846-4521
Mailing Address - Fax:
Practice Address - Street 1:805 W CEDAR ST
Practice Address - Street 2:
Practice Address - City:STANDISH
Practice Address - State:MI
Practice Address - Zip Code:48658-9526
Practice Address - Country:US
Practice Address - Phone:989-846-4521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-19
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI4301097562207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program