Provider Demographics
NPI:1902906183
Name:ISKRA-STEVENSON, LINDA A (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:A
Last Name:ISKRA-STEVENSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5030 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BLOOMFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:43103-1018
Mailing Address - Country:US
Mailing Address - Phone:740-983-0015
Mailing Address - Fax:
Practice Address - Street 1:5030 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:SOUTH BLOOMFIELD
Practice Address - State:OH
Practice Address - Zip Code:43103-1018
Practice Address - Country:US
Practice Address - Phone:740-983-0015
Practice Address - Fax:740-983-4763
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-07-1367 I208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2061236Medicaid
OH2061236Medicaid