Healthcare Provider Details

I. General information

NPI: 1528058088
Provider Name (Legal Business Name): ELIZABETH A LINDENMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 09/23/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 W EDISON RD STE 132
MISHAWAKA IN
46545-2784
US

IV. Provider business mailing address

620 W EDISON RD STE 132
MISHAWAKA IN
46545-2784
US

V. Phone/Fax

Practice location:
  • Phone: 574-369-6393
  • Fax: 574-262-3129
Mailing address:
  • Phone: 574-369-6393
  • Fax: 574-262-3129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01050909A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: