Individual
LYNN MARIE SQUANDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1140 N STATE ST, SAINT IGNACE, MI 49781-1048
(906) 643-8689
(906) 643-4165
Mailing address
524 S COURT AVE, GAYLORD, MI 49735-1215
(989) 350-4105
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5101013512
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0156910035
BCBSM PROVIDER NUMBER
MI
01
—
11289516
CAQH PROVIDER ID
—
01
—
381303843
TAX ID
—
05
—
4547432
—
MI
01
—
CC4805
MEDICARE RR PROV ID
—
Enumeration date
07/12/2006
Last updated
12/31/2024
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