1083870737 NPI number — DR. JOANNA ELIZABETH LINDELL D.O.

Table of content: MS. TERESA LYNN TATE APRN,BC (NPI 1194776039)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083870737 NPI number — DR. JOANNA ELIZABETH LINDELL D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LINDELL
Provider First Name:
JOANNA
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LINDELL
Provider Other First Name:
JOANNA
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1083870737
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
60 REVERE DR
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
NORTHBROOK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60062-1563
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
224-306-1879
Provider Business Mailing Address Fax Number:
224-306-1878

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
60 REVERE DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
NORTHBROOK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60062-1563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
224-306-1879
Provider Business Practice Location Address Fax Number:
224-306-1878
Provider Enumeration Date:
08/01/2008

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: 2084P0800X , with the licence number:  036-125666 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0804X , with the licence number: 036-125666 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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