Provider Demographics
NPI:1699941385
Name:LYNNE M MADEJ D C P A
Entity type:Organization
Organization Name:LYNNE M MADEJ D C P A
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MADEJ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-829-0262
Mailing Address - Street 1:7700 W OLD SHAKOPEE RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55438-3311
Mailing Address - Country:US
Mailing Address - Phone:952-829-0262
Mailing Address - Fax:952-829-0327
Practice Address - Street 1:7700 W OLD SHAKOPEE RD
Practice Address - Street 2:SUITE 120
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55438-3311
Practice Address - Country:US
Practice Address - Phone:952-829-0262
Practice Address - Fax:952-829-0327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNDC 5087261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center