Provider Demographics
NPI:1912930348
Name:MASSIH, LYNA (MD)
Entity type:Individual
Prefix:
First Name:LYNA
Middle Name:
Last Name:MASSIH
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 1:16505 106TH CT
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-4522
Mailing Address - Country:US
Mailing Address - Phone:708-364-1550
Mailing Address - Fax:708-364-1468
Practice Address - Street 1:16505 106TH CT
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-4522
Practice Address - Country:US
Practice Address - Phone:708-364-1550
Practice Address - Fax:708-364-1468
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0795322080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-079532OtherPROFESSIONAL LICENSE