Basic Information
Provider Information
NPI: 1972610939
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LINDHOLM
FirstName: PAUL
MiddleName: ALLEN
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 750 E 34TH ST
Address2:  
City: HIBBING
State: MN
PostalCode: 557462341
CountryCode: US
TelephoneNumber: 2182624881
FaxNumber: 2183626989
Practice Location
Address1: 750 E 34TH ST
Address2:  
City: HIBBING
State: MN
PostalCode: 557462341
CountryCode: US
TelephoneNumber: 2182624881
FaxNumber: 2183626989
Other Information
ProviderEnumerationDate: 08/24/2006
LastUpdateDate: 04/09/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/09/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0001X27867-20WIY Allopathic & Osteopathic PhysiciansRadiologyRadiation Oncology

No ID Information.


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