Provider Demographics
NPI:1679910483
Name:BRAGG, LINDSAY LEE (MD)
Entity type:Individual
Prefix:DR
First Name:LINDSAY
Middle Name:LEE
Last Name:BRAGG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LINDSAY
Other - Middle Name:LEE
Other - Last Name:WIESNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9680 TAMARACK RD STE 100
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2617
Mailing Address - Country:US
Mailing Address - Phone:651-738-0470
Mailing Address - Fax:651-731-5031
Practice Address - Street 1:9680 TAMARACK RD STE 100
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2617
Practice Address - Country:US
Practice Address - Phone:651-738-0470
Practice Address - Fax:651-731-5031
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN60137208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics