Provider Demographics
NPI:1124132956
Name:EATWELL, LINDY C (DO)
Entity type:Individual
Prefix:
First Name:LINDY
Middle Name:C
Last Name:EATWELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 MOULTON AND PARSONS DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:MN
Mailing Address - Zip Code:56081-5550
Mailing Address - Country:US
Mailing Address - Phone:507-375-3261
Mailing Address - Fax:507-375-8636
Practice Address - Street 1:1101 MOULTON AND PARSON DRIVE
Practice Address - Street 2:
Practice Address - City:ST JAMES
Practice Address - State:MN
Practice Address - Zip Code:56081-0460
Practice Address - Country:US
Practice Address - Phone:507-375-3391
Practice Address - Fax:507-375-8636
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN50421207Q00000X
IA3548207Q00000X
MN50241207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA04499OtherWELLMARK
IA0434183Medicaid
IAI11238Medicare ID - Type Unspecified
IAB52569Medicare UPIN