Basic Information
| Provider Information | |||||||||
| NPI: | 1811903073 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LINDSTROM | ||||||||
| FirstName: | STEPHANIE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5100 RELIABLE PKWY | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606860001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3096724809 | ||||||||
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| Practice Location | |||||||||
| Address1: | 901 W WALNUT STREET | ||||||||
| Address2: | |||||||||
| City: | METAMORA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 61548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3093674144 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036102894 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 472306 | 01 | IL | HEALTHLINK | OTHER | IL01L9 | 01 | IL | JOHN DEERE | OTHER | 0361028943 | 05 | IL | MEDICAID | 071728 | 01 | IL | HEALTH ALLIANCE | OTHER | 080182079 | 01 | IL | RAILROAD MEDICARE | OTHER | 7215059 | 01 | IL | BCBS PPO | OTHER |