Healthcare Provider Details

I. General information

NPI: 1174596548
Provider Name (Legal Business Name): LINDA S MILHOLEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10981 HIGHWAY 63
LICKING MO
65542-9869
US

IV. Provider business mailing address

PO BOX 109
HOUSTON MO
65483-0109
US

V. Phone/Fax

Practice location:
  • Phone: 417-399-4707
  • Fax:
Mailing address:
  • Phone: 417-399-4707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2001029380
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: