Provider Demographics
NPI:1376301994
Name:LINDGREN FUNCTIONAL MEDICINE
Entity Type:Organization
Organization Name:LINDGREN FUNCTIONAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:KANTER
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN
Authorized Official - Phone:920-548-1967
Mailing Address - Street 1:2593 DEVELOPMENT DR STE 240
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-4287
Mailing Address - Country:US
Mailing Address - Phone:920-737-1625
Mailing Address - Fax:
Practice Address - Street 1:2593 DEVELOPMENT DR STE 240
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-4287
Practice Address - Country:US
Practice Address - Phone:920-737-1625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center