Healthcare Provider Details

I. General information

NPI: 1891172987
Provider Name (Legal Business Name): LINSEY SANDOVAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINSEY BRADSHAW

II. Dates (important events)

Enumeration Date: 04/28/2015
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 FRANCISCAN DR
LITCHFIELD IL
62056-1778
US

IV. Provider business mailing address

PO BOX 173891
DENVER CO
80217-3891
US

V. Phone/Fax

Practice location:
  • Phone: 217-324-2191
  • Fax:
Mailing address:
  • Phone: 303-306-7783
  • Fax: 303-306-7753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDR.0060420
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301509913
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01100029A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036174662
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: