Provider Demographics
NPI:1609900299
Name:ACKERMAN, LINDSAY SKYE (MD)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:SKYE
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 N 7TH STREET # 250
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006
Mailing Address - Country:US
Mailing Address - Phone:602-354-5770
Mailing Address - Fax:602-354-5607
Practice Address - Street 1:1331 N 7TH ST STE 250
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2722
Practice Address - Country:US
Practice Address - Phone:602-354-5770
Practice Address - Fax:602-354-5607
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ37754207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z123338Medicare PIN
AZZ122739Medicare PIN