Healthcare Provider Details

I. General information

NPI: 1831465632
Provider Name (Legal Business Name): BRET EDWARD LINDSTROM D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2012
Last Update Date: 06/26/2020
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2142 N COVE BLVD
TOLEDO OH
43606-3895
US

IV. Provider business mailing address

5923 RENAISSANCE PL
TOLEDO OH
43623-4709
US

V. Phone/Fax

Practice location:
  • Phone: 419-291-4000
  • Fax:
Mailing address:
  • Phone: 567-408-2002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34.014405
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number2013-02231
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: