Provider Demographics
NPI:1295776391
Name:LINDEMANN, MARK ANDREW (DO)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ANDREW
Last Name:LINDEMANN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 163524
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-3524
Mailing Address - Country:US
Mailing Address - Phone:817-763-8300
Mailing Address - Fax:817-377-9486
Practice Address - Street 1:4545 BELLAIRE DR S
Practice Address - Street 2:SUITE 9
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-1889
Practice Address - Country:US
Practice Address - Phone:817-763-8300
Practice Address - Fax:817-377-9486
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4534207R00000X, 207RG0300X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX612361Medicare PIN