Healthcare Provider Details

I. General information

NPI: 1053434381
Provider Name (Legal Business Name): LINDA C WIDMER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDA C NI M.D.

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 09/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1049 E WILSON ST
BATAVIA IL
60510-2474
US

IV. Provider business mailing address

1049 E WILSON ST
BATAVIA IL
60510-2474
US

V. Phone/Fax

Practice location:
  • Phone: 630-232-2776
  • Fax: 630-315-6565
Mailing address:
  • Phone: 630-232-2776
  • Fax: 630-315-6565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036117674
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: