Provider Demographics
NPI:1770620528
Name:MARION, LINDA D (MD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:D
Last Name:MARION
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 1:1157 WARRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-2367
Mailing Address - Country:US
Mailing Address - Phone:734-995-9714
Mailing Address - Fax:
Practice Address - Street 1:422 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-2404
Practice Address - Country:US
Practice Address - Phone:810-496-5783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0632272084P0800X
MI43010632272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1770620528Medicaid
MI4128391Medicaid
MI260C876120OtherBLUE CROSS BLUE SHIELD
H07168Medicare UPIN
MI0C87612019Medicare ID - Type Unspecified
MI260C876120OtherBLUE CROSS BLUE SHIELD