Healthcare Provider Details

I. General information

NPI: 1174670038
Provider Name (Legal Business Name): LINDY THAKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1983 SLOAN PL STE 1
SAINT PAUL MN
55117-2095
US

IV. Provider business mailing address

1983 SLOAN PL STE 1
SAINT PAUL MN
55117-2095
US

V. Phone/Fax

Practice location:
  • Phone: 651-326-5700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD442767
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD43493
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code2080P1004X
TaxonomyPhysician Nutrition Specialist (Pediatrics)
License Number65308
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD456456
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: