Healthcare Provider Details

I. General information

NPI: 1770506131
Provider Name (Legal Business Name): SUSAN J LINDEMULDER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 04/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3181 SW SAM JACKSON PARK RD
PORTLAND OR
97239-3011
US

IV. Provider business mailing address

8385 SW 24TH AVE
PORTLAND OR
97219-3903
US

V. Phone/Fax

Practice location:
  • Phone: 503-418-5456
  • Fax: 503-494-0714
Mailing address:
  • Phone: 303-913-9146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberMD28659
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number7573
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: