Provider Demographics
NPI:1720074040
Name:LINDHOLM, LAURA ANN (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ANN
Last Name:LINDHOLM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 CIMARRON DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-3812
Mailing Address - Country:US
Mailing Address - Phone:720-204-1870
Mailing Address - Fax:
Practice Address - Street 1:1225 CIMARRON DR
Practice Address - Street 2:SUITE 101
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-3812
Practice Address - Country:US
Practice Address - Phone:720-204-1870
Practice Address - Fax:720-438-7844
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO30396207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01303965Medicaid
CO01303965Medicaid