Provider Demographics
NPI:1346385556
Name:LINDSTROM MEDICAL, PC
Entity type:Organization
Organization Name:LINDSTROM MEDICAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-779-7872
Mailing Address - Street 1:1100 N SAN FRANCISCO ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3260
Mailing Address - Country:US
Mailing Address - Phone:928-779-7872
Mailing Address - Fax:928-774-0508
Practice Address - Street 1:1100 N SAN FRANCISCO ST
Practice Address - Street 2:SUITE B
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3260
Practice Address - Country:US
Practice Address - Phone:928-779-7872
Practice Address - Fax:928-774-0508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27142207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ472093Medicaid
AZ472093Medicaid