Healthcare Provider Details

I. General information

NPI: 1508939562
Provider Name (Legal Business Name): MARTHA J LINN PA C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 02/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 W MITCHELL ST STE 125
PETOSKEY MI
49770-2275
US

IV. Provider business mailing address

416 CONNABLE AVE
PETOSKEY MI
49770-2212
US

V. Phone/Fax

Practice location:
  • Phone: 231-487-4950
  • Fax: 231-487-4951
Mailing address:
  • Phone: 231-487-4950
  • Fax: 231-487-4951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number227
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: