Healthcare Provider Details

I. General information

NPI: 1699729442
Provider Name (Legal Business Name): LINDA PATRICIA CONIGLIO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 12/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5680 MARSH RD SUITE 100
HASLETT MI
48840-8987
US

IV. Provider business mailing address

5680 MARSH RD SUITE 100
HASLETT MI
48840-8987
US

V. Phone/Fax

Practice location:
  • Phone: 517-339-8251
  • Fax: 517-339-9683
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101007201
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: