Provider Demographics
NPI:1053675561
Name:KRUMHOLZ, LINDSEY (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDSEY
Middle Name:
Last Name:KRUMHOLZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LINDSEY
Other - Middle Name:
Other - Last Name:VILLARRUBIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4600 MEMORIAL DR
Mailing Address - Street 2:SUITE 280
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226-5368
Mailing Address - Country:US
Mailing Address - Phone:618-257-2800
Mailing Address - Fax:618-257-9802
Practice Address - Street 1:4600 MEMORIAL DR
Practice Address - Street 2:SUITE 280
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5368
Practice Address - Country:US
Practice Address - Phone:618-257-2800
Practice Address - Fax:618-257-9802
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.137796208000000X
MO2015015502208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics