Healthcare Provider Details

I. General information

NPI: 1760654222
Provider Name (Legal Business Name): MS. LINDA FLEMING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2008
Last Update Date: 01/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4710 LINCOLN HWY 326
MATTESON IL
60443-2316
US

IV. Provider business mailing address

4710 LINCOLN HWY 326
MATTESON IL
60443-2316
US

V. Phone/Fax

Practice location:
  • Phone: 708-790-4000
  • Fax: 708-228-5060
Mailing address:
  • Phone: 708-790-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: