Provider Demographics
NPI:1043241730
Name:MACLEAN, LYNN TAYLOR (MD)
Entity type:Individual
Prefix:DR
First Name:LYNN
Middle Name:TAYLOR
Last Name:MACLEAN
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 1:400 EAST THIRD STREET
Mailing Address - Street 2:ESSENTIA HEALTH DULUTH CLINIC MCL2CRED
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-1951
Mailing Address - Country:US
Mailing Address - Phone:218-786-8364
Mailing Address - Fax:
Practice Address - Street 1:211 S BOUNDARY AVE
Practice Address - Street 2:
Practice Address - City:PROCTOR
Practice Address - State:MN
Practice Address - Zip Code:55810-2306
Practice Address - Country:US
Practice Address - Phone:218-624-4819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN34534207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN046780400Medicaid
MN089002382Medicare PIN
MNF03957Medicare UPIN
MN080117801Medicare PIN