Provider Demographics
NPI:1376530170
Name:LINDEMANN, MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:LINDEMANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 DALE ST
Mailing Address - Street 2:STE #105
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5428
Mailing Address - Country:US
Mailing Address - Phone:907-222-9930
Mailing Address - Fax:907-222-9931
Practice Address - Street 1:4001 DALE ST
Practice Address - Street 2:STE #105
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5428
Practice Address - Country:US
Practice Address - Phone:907-222-9930
Practice Address - Fax:907-222-9931
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4878207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD2323Medicaid
H68062Medicare UPIN
AK152244Medicare ID - Type Unspecified