Healthcare Provider Details

I. General information

NPI: 1750360483
Provider Name (Legal Business Name): LINDA KAY LISTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 12/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NORTHERN ILLINOIS UNIVERSITY HEALTH SERVICES
DEKALB IL
60115-2854
US

IV. Provider business mailing address

NORTHERN ILLINOIS UNIVERSITY HEALTH SERVICE
DEKALB IL
60115-2854
US

V. Phone/Fax

Practice location:
  • Phone: 815-753-1311
  • Fax: 815-753-9599
Mailing address:
  • Phone: 815-753-1311
  • Fax: 815-753-9599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: