Provider Demographics
NPI:1174670038
Name:THAKER, LINDY (MD)
Entity type:Individual
Prefix:
First Name:LINDY
Middle Name:
Last Name:THAKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1983 SLOAN PL STE 1
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55117-2095
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1983 SLOAN PL STE 1
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55117-2095
Practice Address - Country:US
Practice Address - Phone:651-326-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD442767208000000X
TNMD43493208000000X
MN653082080P1004X
DCMD456456208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P1004XAllopathic & Osteopathic PhysiciansPediatricsPhysician Nutrition Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN65308OtherMINNESOTA MEDICAL LICENSE
DCMD456456OtherDC MEDICAL LICENSE