Provider Demographics
NPI:1417041153
Name:LINDAUER, KELLY R (MD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:R
Last Name:LINDAUER
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:PO BOX 80391
Mailing Address - Street 2:
Mailing Address - City:CITY OF INDUSTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91716-8391
Mailing Address - Country:US
Mailing Address - Phone:415-884-3415
Mailing Address - Fax:415-883-0877
Practice Address - Street 1:23004 WHISPERING WOODS
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-8038
Practice Address - Country:US
Practice Address - Phone:415-884-3418
Practice Address - Fax:415-883-0877
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA983712085R0202X
CO447102085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO90473825Medicaid
CO90473825Medicaid
COC809549Medicare PIN
COP00603359Medicare PIN
COC807690Medicare PIN
COC801369Medicare PIN
COC803975Medicare PIN
COC807689Medicare PIN
COC801370Medicare PIN
COP00603359Medicare PIN