Healthcare Provider Details

I. General information

NPI: 1679891832
Provider Name (Legal Business Name): TRISTAN POE LINDBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 E WOODMEN ROAD
COLORADO SPRINGS CO
80923
US

IV. Provider business mailing address

1613 N HARRISON PKWY SUITE 200
SUNRISE FL
33323
US

V. Phone/Fax

Practice location:
  • Phone: 719-571-1000
  • Fax: 954-851-1746
Mailing address:
  • Phone: 954-838-2371
  • Fax: 954-851-1746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number57050
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberDR.0057050
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: