Healthcare Provider Details

I. General information

NPI: 1417925843
Provider Name (Legal Business Name): LINDELL R GENTRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 02/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 HIGHLAND AVE
MADISON WI
53792
US

IV. Provider business mailing address

7974 UW HEALTH CT
MIDDLETON WI
53562-5531
US

V. Phone/Fax

Practice location:
  • Phone: 608-263-8340
  • Fax: 608-265-6533
Mailing address:
  • Phone: 608-829-5485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number23640
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: