Organization
LINDSTROM ORTHOPEDIC CLINIC, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN RUSSELL LINDSTROM MD (MD/OWNER)
(920) 739-5755
Entity
Organization
Contact information
Practice address
2105 E ENTERPRISE AVE, SUITE 110, APPLETON, WV 54913-7862
(920) 739-5755
(920) 739-5151
Mailing address
2105 E ENTERPRISE AVE, SUITE 110, APPLETON, WI 54913-7862
(920) 739-5755
(920) 739-5151
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
22441
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30283000
—
WI
01
—
41708100
MEDICAID DME
WI
Enumeration date
05/23/2006
Last updated
08/22/2020
Update your record
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