Provider Demographics
NPI:1710052287
Name:LINDENMUTH, KIM A (MD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:A
Last Name:LINDENMUTH
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 1:45 S PARK BLVD
Mailing Address - Street 2:SUITE 375
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-6280
Mailing Address - Country:US
Mailing Address - Phone:630-858-4660
Mailing Address - Fax:630-858-9511
Practice Address - Street 1:45 S PARK BLVD
Practice Address - Street 2:SUITE 375
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-6280
Practice Address - Country:US
Practice Address - Phone:630-858-4660
Practice Address - Fax:630-858-9511
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0888960001OtherDMERC
4134055OtherAETNA
02201780OtherBLUE CROSS/BLUE SHIELD
4134055OtherAETNA
ILB44381Medicare UPIN