Healthcare Provider Details

I. General information

NPI: 1134878192
Provider Name (Legal Business Name): ANDERS MICHAEL LINDSTROM PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2022
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 57TH ST N
BIRMINGHAM AL
35217-3328
US

IV. Provider business mailing address

300 EAST HOSPITAL ROAD
FOR GORDON GA
30905-5650
US

V. Phone/Fax

Practice location:
  • Phone: 52-808-3225
  • Fax: 706-787-1745
Mailing address:
  • Phone:
  • Fax: 706-787-1745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberPA.2235
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: