Provider Demographics
NPI:1770591786
Name:DUBAY, LINDA MAE (MD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:MAE
Last Name:DUBAY
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 1:26850 PROVIDENCE PKWY
Mailing Address - Street 2:SUITE 504
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-1213
Mailing Address - Country:US
Mailing Address - Phone:248-559-5115
Mailing Address - Fax:248-559-3022
Practice Address - Street 1:26850 PROVIDENCE PKWY
Practice Address - Street 2:SUITE 504
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1213
Practice Address - Country:US
Practice Address - Phone:248-559-5115
Practice Address - Fax:248-559-3022
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILD053074208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF57526OtherHAP
MI0206368471OtherBCN
MIP00133470OtherRAILROAD MEDICARE
MI0206381091OtherBCBS
MI4361872OtherAETNA
MI0206368471OtherBC
MI312461OtherPRORITY HEALTH
MI112457004OtherUNITED HEALTH PLAN
MI1770591786Medicaid
MI0206381091OtherBCN
MIF57526OtherHAP
MI0206368471OtherBC