Basic Information
| Provider Information | |||||||||
| NPI: | 1619242690 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LINDAUER | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | PAUL | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 E GRAY ST | ||||||||
| Address2: | TB CLINIC | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402021740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025746617 | ||||||||
| FaxNumber: | 5025748666 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 E GRAY ST | ||||||||
| Address2: | TB CLINIC | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402021740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025746617 | ||||||||
| FaxNumber: | 5025748666 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2012 | ||||||||
| LastUpdateDate: | 12/03/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 3007364 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 7100195610 | 05 | KY | MEDICAID |