Provider Demographics
NPI:1083660583
Name:LINDHOLM, KARIN MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:KARIN
Middle Name:MARIE
Last Name:LINDHOLM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 BUCKSKIN DR
Mailing Address - Street 2:
Mailing Address - City:HAILEY
Mailing Address - State:ID
Mailing Address - Zip Code:83333-8752
Mailing Address - Country:US
Mailing Address - Phone:208-788-0908
Mailing Address - Fax:
Practice Address - Street 1:1450 AVIATION DR
Practice Address - Street 2:SUITE 203
Practice Address - City:HAILEY
Practice Address - State:ID
Practice Address - Zip Code:83333-8785
Practice Address - Country:US
Practice Address - Phone:208-727-8295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-1592084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010000939OtherREGENCE BLUE SHIELD ID
IDS2426OtherBLUE CROSS ID
ID002457400Medicaid
ID353306900OtherOWCP ID
ID130025239OtherRAILROAD MEDICARE ID
IDG10415Medicare UPIN
ID002457400Medicaid
ID20001891Medicare PIN