Basic Information
Provider Information
NPI: 1003802810
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LINDELL
FirstName: ERNEST
MiddleName: B.
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1860 PAYSPHERE CIR
Address2:  
City: CHICAGO
State: IL
PostalCode: 606740018
CountryCode: US
TelephoneNumber: 6304699200
FaxNumber: 6302459098
Practice Location
Address1: 1259 RICKERT DR
Address2: SUITE 101
City: NAPERVILLE
State: IL
PostalCode: 605408902
CountryCode: US
TelephoneNumber: 6303551300
FaxNumber: 6303553273
Other Information
ProviderEnumerationDate: 09/27/2005
LastUpdateDate: 01/22/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/22/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207X00000X036065505ILN Allopathic & Osteopathic PhysiciansOrthopaedic Surgery 
207XP3100X036065505ILY Allopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery

ID Information
IDTypeStateIssuerDescription
03606550505IL MEDICAID
20004240501ILRAILROAD MEDICAREOTHER


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