1003802810 NPI number — ERNEST B. LINDELL M.D.

Table of content: DANIEL KING-WAI LOW MD (NPI 1881710432)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003802810 NPI number — ERNEST B. LINDELL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LINDELL
Provider First Name:
ERNEST
Provider Middle Name:
B.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003802810
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1860 PAYSPHERE CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60674-0018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-469-9200
Provider Business Mailing Address Fax Number:
630-245-9098

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1259 RICKERT DR
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
NAPERVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60540-8902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-355-1300
Provider Business Practice Location Address Fax Number:
630-355-3273
Provider Enumeration Date:
09/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  036065505 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XP3100X , with the licence number: 036065505 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200042405 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036065505 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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