Provider Demographics
NPI:1528058195
Name:ANDERSON, LINDA A
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:A
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 HOBSON RD
Mailing Address - Street 2:STE 116
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-8137
Mailing Address - Country:US
Mailing Address - Phone:630-416-3300
Mailing Address - Fax:630-646-5648
Practice Address - Street 1:1220 HOBSON RD
Practice Address - Street 2:SUITE 116
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-8137
Practice Address - Country:US
Practice Address - Phone:630-416-3300
Practice Address - Fax:630-646-5648
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036086971207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036086971 2Medicaid
IL160050500Medicare PIN
ILL79928Medicare PIN
ILL61784Medicare PIN
F63163Medicare UPIN
IL160037559Medicare PIN
ILL61783Medicare PIN