Provider Demographics
NPI:1033126008
Name:MERSHON, LYNN RAE (DO)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:RAE
Last Name:MERSHON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:RAE
Other - Last Name:DECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1990 LARKIN AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123
Mailing Address - Country:US
Mailing Address - Phone:847-289-5727
Mailing Address - Fax:847-888-5469
Practice Address - Street 1:1990 LARKIN AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123
Practice Address - Country:US
Practice Address - Phone:847-289-5727
Practice Address - Fax:847-888-5469
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4921788OtherBLUE CROSS BLUE SHIELD
IL4921788OtherBLUE CROSS BLUE SHIELD
ILL78056Medicare ID - Type Unspecified