=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053285254
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRACEY LINDEMAN MD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2025
-----------------------------------------------------
Last Update Date | 10/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 250 BLOSSOM ST STE 100
-----------------------------------------------------
City | WEBSTER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77598-4243
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-724-0190
-----------------------------------------------------
Fax | 832-632-2415
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 250 BLOSSOM ST STE 100
-----------------------------------------------------
City | WEBSTER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77598-4243
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-724-0190
-----------------------------------------------------
Fax | 832-632-2415
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | TRACEY LINDEMAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 713-828-9037
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------