Provider Demographics
NPI:1033184304
Name:LINDSTROM, DEAN RICHARD III (MD)
Entity Type:Individual
Prefix:MR
First Name:DEAN
Middle Name:RICHARD
Last Name:LINDSTROM
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 PINE ST
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3117
Mailing Address - Country:US
Mailing Address - Phone:321-802-6697
Mailing Address - Fax:321-802-3158
Practice Address - Street 1:1314 PINE ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3117
Practice Address - Country:US
Practice Address - Phone:321-802-6697
Practice Address - Fax:321-802-3158
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME111877207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004547400Medicaid
FL004547400Medicaid
WI000602385Medicare ID - Type Unspecified
WI34487400Medicaid
I04755Medicare UPIN
WI000468715Medicare ID - Type Unspecified
WI000568730Medicare ID - Type Unspecified
WI2000303OtherPHYSICIANS PLUS
FL004547400Medicaid