Healthcare Provider Details

I. General information

NPI: 1093786808
Provider Name (Legal Business Name): LORRAINE ANNETTE LINDSTROM LEIFER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LORI A. LINDSTROM M.D.

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4881 NE GOODVIEW CIR
LEES SUMMIT MO
64064-1996
US

IV. Provider business mailing address

PO BOX 411851
KANSAS CITY MO
64141-1851
US

V. Phone/Fax

Practice location:
  • Phone: 913-574-2350
  • Fax: 913-574-2769
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberR3K00
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number04-22044
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number2022-02943
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: