Healthcare Provider Details

I. General information

NPI: 1144434895
Provider Name (Legal Business Name): PIA LINDSTROM LUEDTKE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 10/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W CALIFORNIA BLVD HUNTINGTON MEMORIAL HOSPITAL
PASADENA CA
91105-3010
US

IV. Provider business mailing address

223 N 1ST AVE #201
ARCADIA CA
91006-7027
US

V. Phone/Fax

Practice location:
  • Phone: 626-397-5139
  • Fax:
Mailing address:
  • Phone: 626-698-7246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA90407
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: