Provider Demographics
NPI:1093786808
Name:LINDSTROM LEIFER, LORRAINE ANNETTE (MD)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:ANNETTE
Last Name:LINDSTROM LEIFER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:A
Other - Last Name:LINDSTROM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 411851
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64141-1851
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4881 NE GOODVIEW CIR
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-1996
Practice Address - Country:US
Practice Address - Phone:913-574-2350
Practice Address - Fax:913-574-2769
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3K002085R0001X
KS04-220442085R0001X
NC2022-029432085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100116190EMedicaid
KS100116190DMedicaid
MO1093786808Medicaid
KSP01817348OtherRAILROAD MEDICARE
MOMA3347012Medicare PIN
KS100116190EMedicaid
KSK40000054Medicare PIN