Provider Demographics
NPI:1316558349
Name:LINDSEY VANDYKE, D.O. PLLC
Entity Type:Organization
Organization Name:LINDSEY VANDYKE, D.O. PLLC
Other - Org Name:ADVANCED INSTITUTE FOR DIABETES & ENDOCRINOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/MANAGING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDYKE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-380-4880
Mailing Address - Street 1:1900 MATLOCK RD STE 304
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-4435
Mailing Address - Country:US
Mailing Address - Phone:817-380-4880
Mailing Address - Fax:817-788-8416
Practice Address - Street 1:1900 MATLOCK RD STE 304
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-4435
Practice Address - Country:US
Practice Address - Phone:817-380-4880
Practice Address - Fax:817-788-8416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-13
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXR7919OtherMEDICAL LICENSE NUMBER