Provider Demographics
NPI:1790128098
Name:MAIRURA, LINAH KWAMBOKA (MD)
Entity type:Individual
Prefix:
First Name:LINAH
Middle Name:KWAMBOKA
Last Name:MAIRURA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:950 E BELT LINE RD STE 150
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-2424
Mailing Address - Country:US
Mailing Address - Phone:972-291-7863
Mailing Address - Fax:972-291-0942
Practice Address - Street 1:1001 HEATHER DR
Practice Address - Street 2:
Practice Address - City:MAHOMET
Practice Address - State:IL
Practice Address - Zip Code:61853-2754
Practice Address - Country:US
Practice Address - Phone:217-586-8400
Practice Address - Fax:217-586-5093
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-17
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXQ9426207Q00000X
KS42727207Q00000X
IL036172703207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine