Provider Demographics
NPI:1245405786
Name:LINDENWALD MEDICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:LINDENWALD MEDICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHAUNA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOBERTGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-887-5734
Mailing Address - Street 1:PO BOX 643197
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45264-3197
Mailing Address - Country:US
Mailing Address - Phone:513-557-3196
Mailing Address - Fax:513-557-3347
Practice Address - Street 1:3570 PLEASANT AVE
Practice Address - Street 2:SUITE A
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45015-1747
Practice Address - Country:US
Practice Address - Phone:513-863-6463
Practice Address - Fax:513-863-2440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35074089207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2294959Medicaid
OH9318011Medicare PIN
FLCK945AMedicare PIN
OH6355840001Medicare NSC