Provider Demographics
NPI:1538236740
Name:MEISLES, LYNN D (MD)
Entity type:Individual
Prefix:DR
First Name:LYNN
Middle Name:D
Last Name:MEISLES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BRISTOL RD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-3200
Mailing Address - Country:US
Mailing Address - Phone:847-784-9334
Mailing Address - Fax:847-784-9336
Practice Address - Street 1:675 W NORTH AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-1634
Practice Address - Country:US
Practice Address - Phone:708-450-5085
Practice Address - Fax:708-344-3909
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036076639207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036076639Medicaid
IL526020Medicare ID - Type Unspecified
ILE83647Medicare UPIN