Healthcare Provider Details

I. General information

NPI: 1902906183
Provider Name (Legal Business Name): LINDA A ISKRA-STEVENSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 N WALNUT ST
SOUTH BLOOMFIELD OH
43103-1018
US

IV. Provider business mailing address

5030 N WALNUT ST
SOUTH BLOOMFIELD OH
43103-1018
US

V. Phone/Fax

Practice location:
  • Phone: 740-983-0015
  • Fax: 740-983-4763
Mailing address:
  • Phone: 740-983-0015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35-07-1367 I
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: