Provider Demographics
NPI:1902156839
Name:KRAWCZUK, LINDSEY MICHELLE (DO)
Entity Type:Individual
Prefix:DR
First Name:LINDSEY
Middle Name:MICHELLE
Last Name:KRAWCZUK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:LINDSEY
Other - Middle Name:MICHELLE
Other - Last Name:GADDIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 4046
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65808-4046
Mailing Address - Country:US
Mailing Address - Phone:417-269-5712
Mailing Address - Fax:417-269-7567
Practice Address - Street 1:3801 S. NATIONAL AVE.
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807
Practice Address - Country:US
Practice Address - Phone:417-269-9812
Practice Address - Fax:417-269-9853
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1875751164207P00000X
MO2017011897207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200045728Medicaid