Healthcare Provider Details

I. General information

NPI: 1477734978
Provider Name (Legal Business Name): LINDA HOTCHKISS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2007
Last Update Date: 06/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22811 GREATER MACK AVE STE 104
SAINT CLAIR SHORES MI
48080
US

IV. Provider business mailing address

8995 W SCENIC LAKE DR
LAINGSBURG MI
48848-8787
US

V. Phone/Fax

Practice location:
  • Phone: 313-410-2605
  • Fax:
Mailing address:
  • Phone: 313-410-2605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301041648
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: