Provider Demographics
NPI:1235211822
Name:PAUL LINDHOLM, PC
Entity Type:Organization
Organization Name:PAUL LINDHOLM, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:LINDHOLM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:218-362-6784
Mailing Address - Street 1:1200 E 25TH ST
Mailing Address - Street 2:
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-3897
Mailing Address - Country:US
Mailing Address - Phone:218-312-3002
Mailing Address - Fax:218-312-3003
Practice Address - Street 1:750 E 34TH ST
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-2341
Practice Address - Country:US
Practice Address - Phone:218-362-6784
Practice Address - Fax:218-362-6684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNDG4464OtherRAILROAD MEDICARE
MN151388OtherUCARE
MN467L9PAOtherBLUE CROSS BLUE SHIELD
MN216217200Medicaid
MN151388OtherUCARE