Healthcare Provider Details

I. General information

NPI: 1073547501
Provider Name (Legal Business Name): JULIE A LINDHOLM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 10/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 NORTH NAVAJO DRIVE
PAGE AZ
86040
US

IV. Provider business mailing address

PO BOX 1447 501 NORTH NAVAJO DRIVE
PAGE AZ
86040-0600
US

V. Phone/Fax

Practice location:
  • Phone: 928-645-2424
  • Fax: 928-645-0106
Mailing address:
  • Phone: 928-645-2424
  • Fax: 928-645-0106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number34436
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: