Provider Demographics
NPI:1902833114
Name:LINDEMULDER, JAMES (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:LINDEMULDER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 ELKHART RD
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-1118
Mailing Address - Country:US
Mailing Address - Phone:574-364-2875
Mailing Address - Fax:
Practice Address - Street 1:1122 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-3819
Practice Address - Country:US
Practice Address - Phone:574-533-0560
Practice Address - Fax:574-533-1716
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02004713A207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4593515Medicaid
MI4593515Medicaid
MIF74217Medicare UPIN