Lynne R. Mielke, M.D.

Primary specialty

Neurodevelopmental Disabilities PhysicianTaxonomy code 2084P0005X

License

G59017 Issued in CA

Practice address

4463 Stoneridge Dr Ste a
Pleasanton, CA 94588-8402

Phone

(925) 846-6300

Fax

(925) 846-6323

NPI assigned

Sep 21, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Oct 1, 2014 through Oct 1, 2026

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1700985413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4463 STONERIDGE DR STE A",
            "city": "PLEASANTON",
            "state": "CA",
            "postal_code": "945888402",
            "telephone_number": "925-846-6300",
            "fax_number": "925-846-6323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4463 STONERIDGE DR STE A",
            "city": "PLEASANTON",
            "state": "CA",
            "postal_code": "945888402",
            "telephone_number": "925-846-6300",
            "fax_number": "925-846-6323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIELKE",
        "first_name": "LYNNE",
        "middle_name": "R.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0005X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurodevelopmental Disabilities",
            "state": "CA",
            "license": "G59017",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Neurodevelopmental Disabilities Physician in Pleasanton, CA
• Providers in Pleasanton, CA by specialty
• Neurodevelopmental Disabilities Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.