Provider Demographics
NPI:1568553634
Name:MCCOLLUM, LYNDA CAROL (MD)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:CAROL
Last Name:MCCOLLUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LYNDA
Other - Middle Name:CAROL
Other - Last Name:MCCOLLUM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:8803 N MERIDIAN ST
Mailing Address - Street 2:350
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5317
Mailing Address - Country:US
Mailing Address - Phone:317-848-3040
Mailing Address - Fax:317-848-5380
Practice Address - Street 1:8803 N MERIDIAN ST
Practice Address - Street 2:350
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5317
Practice Address - Country:US
Practice Address - Phone:317-848-3040
Practice Address - Fax:317-848-5380
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01034564208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics