Healthcare Provider Details

I. General information

NPI: 1417041153
Provider Name (Legal Business Name): KELLY R. LINDAUER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4520 UTICA ST
DENVER CO
80212-2529
US

IV. Provider business mailing address

PO BOX 80391
CITY OF INDUSTRY CA
91716-8391
US

V. Phone/Fax

Practice location:
  • Phone: 415-464-8081
  • Fax:
Mailing address:
  • Phone: 415-884-3415
  • Fax: 415-883-0877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA98371
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD2025-1306
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number44710
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: