Provider Demographics
NPI:1578788402
Name:VANDERWALDE, LINDI H (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDI
Middle Name:H
Last Name:VANDERWALDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LINDI
Other - Middle Name:HANNA
Other - Last Name:VANDERWALDE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:419 ESSEX PL
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2422
Mailing Address - Country:US
Mailing Address - Phone:310-497-3575
Mailing Address - Fax:
Practice Address - Street 1:6215 HUMPHREYS BLVD.
Practice Address - Street 2:SUITE 208
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120
Practice Address - Country:US
Practice Address - Phone:901-227-8950
Practice Address - Fax:901-227-8951
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN50312208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR214525001Medicaid
MS02483050Medicaid
TN1532986Medicaid
AR214525001Medicaid