Provider Demographics
NPI:1982899985
Name:LINDELL, KEVIN V (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:V
Last Name:LINDELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 FREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MORGAN
Mailing Address - State:CO
Mailing Address - Zip Code:80701-3554
Mailing Address - Country:US
Mailing Address - Phone:970-867-7549
Mailing Address - Fax:
Practice Address - Street 1:220 E BEAVER AVE
Practice Address - Street 2:
Practice Address - City:FORT MORGAN
Practice Address - State:CO
Practice Address - Zip Code:80701-3103
Practice Address - Country:US
Practice Address - Phone:970-867-8221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24719207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01247196Medicaid
COD24501Medicare UPIN
CO01247196Medicaid