Provider Demographics
NPI:1235389727
Name:TATE, LINDSAY BRIANN (MD)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:BRIANN
Last Name:TATE
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 1:347 SCHULZKI LN
Mailing Address - Street 2:
Mailing Address - City:EAST PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61611-9487
Mailing Address - Country:US
Mailing Address - Phone:864-293-9915
Mailing Address - Fax:
Practice Address - Street 1:19 OLT AVE
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-6214
Practice Address - Country:US
Practice Address - Phone:309-353-6301
Practice Address - Fax:407-648-3686
Is Sole Proprietor?:No
Enumeration Date:2008-09-22
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036133748207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program