Provider Demographics
NPI:1992884597
Name:LYNCH, MICHAEL BLAIR (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BLAIR
Last Name:LYNCH
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 35808
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85740
Mailing Address - Country:US
Mailing Address - Phone:520-297-7826
Mailing Address - Fax:520-544-0060
Practice Address - Street 1:6200 N LA CHOLLA BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741
Practice Address - Country:US
Practice Address - Phone:520-297-7826
Practice Address - Fax:520-544-0060
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL0064926207ZP0102X
AZ36167207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F79247Medicare UPIN