Provider Demographics
NPI:1750919510
Name:TUNTLAND, LINDSEY E (MD)
Entity type:Individual
Prefix:DR
First Name:LINDSEY
Middle Name:E
Last Name:TUNTLAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:ELIZABETH
Other - Last Name:TUNTLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 735044
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-5044
Mailing Address - Country:US
Mailing Address - Phone:262-275-2101
Mailing Address - Fax:
Practice Address - Street 1:525 KENOSHA ST
Practice Address - Street 2:
Practice Address - City:WALWORTH
Practice Address - State:WI
Practice Address - Zip Code:53184-9512
Practice Address - Country:US
Practice Address - Phone:262-275-2101
Practice Address - Fax:262-275-0752
Is Sole Proprietor?:No
Enumeration Date:2020-03-28
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI76190207Q00000X
390200000X
WI76190-20208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100182847Medicaid