Provider Demographics
NPI:1164411260
Name:LINDENBERG, JUDAH R (MD)
Entity Type:Individual
Prefix:
First Name:JUDAH
Middle Name:R
Last Name:LINDENBERG
Suffix:
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 1:12000 MCCRACKEN RD
Mailing Address - Street 2:SUITE 357
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-2964
Mailing Address - Country:US
Mailing Address - Phone:216-332-0920
Mailing Address - Fax:216-332-0950
Practice Address - Street 1:12000 MCCRACKEN RD
Practice Address - Street 2:SUITE 357
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-2964
Practice Address - Country:US
Practice Address - Phone:216-332-0920
Practice Address - Fax:216-332-0950
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0806442084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH736527OtherBUCKEYE
OH203990467027OtherCARESOURCE
OH2589471Medicaid
OHR80644OtherSUMMACARE
OH000000489132OtherANTHEM BLUE SHIELD
OH352040OtherWELLCARE
OHP00331602Medicare PIN
OHI31240Medicare UPIN
OH736527OtherBUCKEYE