Healthcare Provider Details

I. General information

NPI: 1992155741
Provider Name (Legal Business Name): LINDSAY MARIE TOLKSDORF D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDSAY MARIE BREWSTER DO

II. Dates (important events)

Enumeration Date: 06/13/2016
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 SAINT ELIZABETH BLVD STE 4000
O FALLON IL
62269
US

IV. Provider business mailing address

180 S 3RD ST SUITE 300
BELLEVILLE IL
62220-1952
US

V. Phone/Fax

Practice location:
  • Phone: 618-233-7880
  • Fax:
Mailing address:
  • Phone: 618-233-5480
  • Fax: 618-222-4790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125069133
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2018021677
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: