Lynn Van Wagnen MD PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

038051 Issued in MI

Legal business name

LYNN VAN WAGNEN MD PC

Practice address

1310 Greenwood Ave
Jackson, MI 49203-3077

Phone

(517) 787-1990

Fax

(517) 787-9183

NPI assigned

Jul 1, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Lynn Clark Van Wagnen, MDNPI 1609833359

Title

Physician

Phone

(517) 787-1990

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lynn Clark Vanwagnen, MD

  • Internal Medicine Physician
  • Jackson, MI
  • NPI 1609833359
  Medicare reassignment NPD Authorized official
• Aaron Michael Vanwagnen, MD

  • Internal Medicine Physician
  • Jackson, MI
  • NPI 1245305044
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1246406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1248652800000",
    "number": "1396973129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1310 GREENWOOD AVE",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492033077",
            "telephone_number": "517-787-1990",
            "fax_number": "517-787-9183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 GREENWOOD AVE",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492033077",
            "telephone_number": "517-787-1990",
            "fax_number": "517-787-9183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LYNN VAN WAGNEN MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-01",
        "last_updated": "2009-07-27",
        "status": "A",
        "authorized_official_last_name": "VAN WAGNEN",
        "authorized_official_first_name": "LYNN",
        "authorized_official_middle_name": "CLARK",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "517-787-1990",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "038051",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Luxottica Retail North America Inc
• Luxottica Retail North America Inc
• Stephanie Renee' Lyerla, LLMSW
• Gary L Lynd, DO
• Lynda Hammond MD PLLC
• Kija K Lyons, RN,BSN
• Olivia Kathleen Lyons
• Jennifer Ann Maccagnano, D.O.
• Terrance Wayne Macgregor, MD
• Deepa S Macha, MD

• Internal Medicine Physician in Jackson, MI
• Providers in Jackson, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.