Healthcare Provider Details

I. General information

NPI: 1821180688
Provider Name (Legal Business Name): LINDSEY MA, MD, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 W WILLOW KNOLLS DR
PEORIA IL
61614-8121
US

IV. Provider business mailing address

3300 W WILLOW KNOLLS DR
PEORIA IL
61614-8121
US

V. Phone/Fax

Practice location:
  • Phone: 309-683-0200
  • Fax: 309-683-0201
Mailing address:
  • Phone: 309-683-0200
  • Fax: 309-683-0201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: MR. LINDSEY MA
Title or Position: PRESIDENT
Credential: MD
Phone: 309-683-0200