MEDICARE: DR. CARL MARTIN LINDQUIST D.O.

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	207RI0200X	Infectious Disease Physician	036-62761	IL
2	207RI0200X	Infectious Disease Physician	036-062761	IL
3	207RI0200X	Infectious Disease Physician	5303	OK

General Provider Information

NPI Number	:	1881682839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARL MARTIN LINDQUIST D.O.

Provider Business Mailing Address
First Line	:	7050 AIR DEPOT BLVD
Second Line	:
City	:	TINKER AFB
State	:	OK
Zip	:	73145-8716
Country	:	US
Telephone Number	:	405-582-6805
Fax Number	:	405-734-3404

Provider Business Practice Location Address
First Line	:	72 AMDS/SGPO
Second Line	:	8941 ENTRANCE RD A BLD 3334
City	:	TINKER AFB
State	:	OK
Zip	:	73145-3065
Country	:	US
Telephone Number	:	405-582-6805
Fax Number	:	405-734-3404

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

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	05/07/2018

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