1861706160 NPI number — MARTHA C LINDSTROM N.P.

Table of content: MARTHA C LINDSTROM N.P. (NPI 1861706160)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861706160 NPI number — MARTHA C LINDSTROM N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LINDSTROM
Provider First Name:
MARTHA
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CRONIN
Provider Other First Name:
MARTHA
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
N.P.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1861706160
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 E WISCONSIN AVE
Provider Second Line Business Mailing Address:
SUITE 2000
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53202-4815
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-290-6720
Provider Business Mailing Address Fax Number:
414-290-6755

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
731 S. IL-21
Provider Second Line Business Practice Location Address:
STE 110
Provider Business Practice Location Address City Name:
GURNEE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60031-3204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-360-8440
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/29/2010

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: 363L00000X , with the licence number:  41341644 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 209-008244 , 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: 1861706160 . This is a "TRICARE NORTH REGION" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: P00932260 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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