Provider Demographics
NPI:1538177886
Name:LINDBERG, RUTH FARRALES (MD)
Entity type:Individual
Prefix:DR
First Name:RUTH
Middle Name:FARRALES
Last Name:LINDBERG
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Gender:F
Credentials:MD
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Mailing Address - Street 1:240 MAPLE AVE
Mailing Address - Street 2:PROHEALTH CARE MEDICAL ASSOCIATES INC.
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149-8475
Mailing Address - Country:US
Mailing Address - Phone:262-928-1900
Mailing Address - Fax:262-363-1949
Practice Address - Street 1:240 MAPLE AVE
Practice Address - Street 2:PROHEALTH CARE MEDICAL ASSOCIATES INC.
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149-8475
Practice Address - Country:US
Practice Address - Phone:262-928-1900
Practice Address - Fax:262-363-1949
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2013-04-09
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Provider Licenses
StateLicense IDTaxonomies
TN41108207Q00000X
WI47326207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3826597Medicaid
TN3826597Medicaid
WI68375Medicare PIN