MEDICARE: GEORGE LINDALL LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	LP0826	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3M390LI	OTHER	MN	BCBS IPN
2	104022	OTHER	MN	HEALTH PARTNERS FIN
3	47343LI	OTHER	MN	BCBS CLINIC
4	LP0826	OTHER	MN	LICENSE NUMBER

General Provider Information

NPI Number	:	1215058649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE LINDALL LP

Provider Business Mailing Address
First Line	:	2712 E MINNEHAHA PKWY
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-3743
Country	:	US
Telephone Number	:	612-282-2750
Fax Number	:

Provider Business Practice Location Address
First Line	:	2712 E MINNEHAHA PKWY
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-3743
Country	:	US
Telephone Number	:	612-282-2750
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	07/08/2007

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Directions to “ GEORGE LINDALL LP” Practice Location

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