Provider Demographics
NPI:1942910682
Name:WEIDERT, LINDY (RDCS)
Entity Type:Individual
Prefix:
First Name:LINDY
Middle Name:
Last Name:WEIDERT
Suffix:
Gender:F
Credentials:RDCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34
Mailing Address - Street 2:
Mailing Address - City:NORTH AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60542-0034
Mailing Address - Country:US
Mailing Address - Phone:630-989-8585
Mailing Address - Fax:
Practice Address - Street 1:48 SILVER TRL
Practice Address - Street 2:
Practice Address - City:NORTH AURORA
Practice Address - State:IL
Practice Address - Zip Code:60542-1581
Practice Address - Country:US
Practice Address - Phone:630-989-8585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2560642085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound