Basic Information
| Provider Information | |||||||||
| NPI: | 1235211822 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PAUL LINDHOLM, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 E 25TH ST | ||||||||
| Address2: | |||||||||
| City: | HIBBING | ||||||||
| State: | MN | ||||||||
| PostalCode: | 557463897 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2183123002 | ||||||||
| FaxNumber: | 2183123003 | ||||||||
| Practice Location | |||||||||
| Address1: | 750 E 34TH ST | ||||||||
| Address2: | |||||||||
| City: | HIBBING | ||||||||
| State: | MN | ||||||||
| PostalCode: | 557462341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2183626784 | ||||||||
| FaxNumber: | 2183626684 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2006 | ||||||||
| LastUpdateDate: | 05/25/2011 | ||||||||
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| AuthorizedOfficialLastName: | LINDHOLM | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2183626784 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | DG4464 | 01 | MN | RAILROAD MEDICARE | OTHER | 151388 | 01 | MN | UCARE | OTHER | 467L9PA | 01 | MN | BLUE CROSS BLUE SHIELD | OTHER | 216217200 | 05 | MN | MEDICAID |