Provider Demographics
NPI:1972563559
Name:DENNIS, LYNN MARIE (DPM)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:MARIE
Last Name:DENNIS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:MARIE
Other - Last Name:GRZESIKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:604 N UNION ST STE 2
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:IL
Mailing Address - Zip Code:62656-1578
Mailing Address - Country:US
Mailing Address - Phone:217-732-9276
Mailing Address - Fax:217-732-9276
Practice Address - Street 1:604 N UNION ST STE 2
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:IL
Practice Address - Zip Code:62656-1578
Practice Address - Country:US
Practice Address - Phone:217-732-9276
Practice Address - Fax:217-732-9276
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2016-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004829213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL8422156OtherBC BS
U70953Medicare UPIN
IL8422156OtherBC BS
IL429020Medicare PIN