Individual
MARK LINDSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
4848 S 6TH ST, MILWAUKEE, WI 53221-2462
(414) 769-2540
Mailing address
4425 N PORT WASHINGTON RD, ATTN: CLINIC CREDENTIALING, GLENDALE, WI 53212-1082
(414) 769-2540
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
33822
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30056400
—
WI
Enumeration date
09/20/2006
Last updated
06/12/2012
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