Provider Demographics
NPI:1003116690
Name:LINDEEN, CHUCK E (LMT)
Entity Type:Individual
Prefix:MR
First Name:CHUCK
Middle Name:E
Last Name:LINDEEN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 11TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-1821
Mailing Address - Country:US
Mailing Address - Phone:727-742-3319
Mailing Address - Fax:727-822-8444
Practice Address - Street 1:115 11TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-1821
Practice Address - Country:US
Practice Address - Phone:727-742-3319
Practice Address - Fax:727-822-8444
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 58357251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health