Basic Information
Provider Information
NPI: 1841579661
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LINDGREN
FirstName: BRETT
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 31309
Address2:  
City: LOS ANGELES
State: CA
PostalCode: 900310309
CountryCode: US
TelephoneNumber: 3234425100
FaxNumber:  
Practice Location
Address1: 1520 SAN PABLO ST STE 1000
Address2:  
City: LOS ANGELES
State: CA
PostalCode: 900335312
CountryCode: US
TelephoneNumber: 3234425100
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/10/2011
LastUpdateDate: 08/29/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/29/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RP1001XH84872MDN Allopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
207T00000XOT013960PAN Allopathic & Osteopathic PhysiciansNeurological Surgery 
207RC0200X20A14032CAY Allopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine

No ID Information.


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