Provider Demographics
NPI:1972936581
Name:LINDHEIMER, MARSHALL DAVID
Entity type:Individual
Prefix:PROF
First Name:MARSHALL
Middle Name:DAVID
Last Name:LINDHEIMER
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:MARSHALL
Other - Middle Name:DAVID
Other - Last Name:LINDHEIMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5807 S DORCHESTER AVE
Mailing Address - Street 2:5E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1729
Mailing Address - Country:US
Mailing Address - Phone:773-684-1049
Mailing Address - Fax:773-702-5160
Practice Address - Street 1:5807 S DORCHESTER AVE
Practice Address - Street 2:5E
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1729
Practice Address - Country:US
Practice Address - Phone:773-684-1049
Practice Address - Fax:773-702-5160
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036043010207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036043010OtherSTATE OF ILLINOIS LICENSE (PHYSICIAN NAD SURGEON