Healthcare Provider Details

I. General information

NPI: 1609047844
Provider Name (Legal Business Name): LINDA DZIFA IDUN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDA DZIFA GIDIGASU MD

II. Dates (important events)

Enumeration Date: 03/16/2008
Last Update Date: 03/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 N MONROE DR
XENIA OH
45385-1619
US

IV. Provider business mailing address

1141 N MONROE DR
XENIA OH
45385-1619
US

V. Phone/Fax

Practice location:
  • Phone: 937-352-2581
  • Fax: 937-352-3580
Mailing address:
  • Phone: 937-352-2581
  • Fax: 937-352-3580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number090786
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: