Healthcare Provider Details

I. General information

NPI: 1568437754
Provider Name (Legal Business Name): LINDA M TAYEH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDA TAYEH-KLINSKY

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 S GARY AVE
BLOOMINGDALE IL
60108-2213
US

IV. Provider business mailing address

233 S GARY AVE
BLOOMINGDALE IL
60108-2213
US

V. Phone/Fax

Practice location:
  • Phone: 630-924-4009
  • Fax: 630-924-9671
Mailing address:
  • Phone: 630-924-4009
  • Fax: 630-924-9671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number36088523
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number36088523
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: