Individual provider Active NPI

Lisa M Flynn, MD

  • Vascular Surgery Physician
  • Detroit, MI
National Provider Identifier
1629070271
Registry record updated Dec 27, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
4301061622 Issued in MI
Practice address
4160 John R
Suite 615
Detroit, MI 48201-2020
Phone
(313) 745-4195
Fax
(313) 993-8669
NPI assigned
Aug 12, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 4301061622 MI
Vascular Surgery Physician 2086S0129X 4301061622 MI Primary

Addresses

Primary practice location

4160 John R
Suite 615
Detroit, MI 48201-2020

Mailing address

1420 Stephenson Hwy
Suite 400-Credentialing
Troy, MI 48083-1189
Phone (248) 581-5974

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
St Clair Specialty Physicians PC Vascular Surgery Current Accepting new patients
Henry Ford Health St. John Hospital Past Accepting new patients

Locations

23857 Greenfield Rd
Southfield, MI 48075
Phone (248) 569-6111

45640 Schoenherr Rd
Ste B
Utica, MI 48315
Phone (586) 247-4300

Interoperability endpoints

  • Direct secure messaging: lflynn892504@direct.hfhs.org

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1123804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1388102400000",
    "number": "1629070271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1420 STEPHENSON HWY",
            "address_2": "SUITE 400-CREDENTIALING",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480831189",
            "telephone_number": "248-581-5974",
            "fax_number": "248-581-5640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4160 JOHN R",
            "address_2": "SUITE 615",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012020",
            "telephone_number": "313-745-4195",
            "fax_number": "313-993-8669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLYNN",
        "first_name": "LISA",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-12",
        "last_updated": "2013-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": "4301061622",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "MI",
            "license": "4301061622",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.