Provider Demographics
NPI:1114018652
Name:C RONALD LINDBERG MD SC
Entity Type:Organization
Organization Name:C RONALD LINDBERG MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:C RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:708-579-3090
Mailing Address - Street 1:6463 GARFIELD RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5285
Mailing Address - Country:US
Mailing Address - Phone:708-579-3090
Mailing Address - Fax:708-579-3094
Practice Address - Street 1:6463 GARFIELD RIDGE CT
Practice Address - Street 2:
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-5285
Practice Address - Country:US
Practice Address - Phone:708-579-3090
Practice Address - Fax:708-579-3094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2016-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL020526OtherCHAMPUS
IL0021609698OtherBLUE CROSS BLUE SHIELD
IL036055534Medicaid
IL0754820001Medicare NSC
IL0021609698OtherBLUE CROSS BLUE SHIELD
ILL020526OtherCHAMPUS
IL214158Medicare PIN