Healthcare Provider Details

I. General information

NPI: 1760561344
Provider Name (Legal Business Name): DR. LINDA MEZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 05/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1859 S BLUE ISLAND AVE
CHICAGO IL
60608
US

IV. Provider business mailing address

1201 W ADAMS ST UNIT 808
CHICAGO IL
60607-2867
US

V. Phone/Fax

Practice location:
  • Phone: 312-666-5455
  • Fax: 312-733-5327
Mailing address:
  • Phone: 312-850-1583
  • Fax: 312-733-5327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036110283
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: