Provider Demographics
NPI:1609631142
Name:LINDBLOM, TOM
Entity Type:Individual
Prefix:
First Name:TOM
Middle Name:
Last Name:LINDBLOM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4702 BLANDING CT
Mailing Address - Street 2:
Mailing Address - City:BIG LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55309-8214
Mailing Address - Country:US
Mailing Address - Phone:612-670-7216
Mailing Address - Fax:
Practice Address - Street 1:4702 BLANDING CT
Practice Address - Street 2:
Practice Address - City:BIG LAKE
Practice Address - State:MN
Practice Address - Zip Code:55309-8214
Practice Address - Country:US
Practice Address - Phone:612-670-7216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNBC740997171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications