Healthcare Provider Details

I. General information

NPI: 1235197161
Provider Name (Legal Business Name): LINDA ALIC MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 06/26/2022
Certification Date: 06/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 DOVER LN
ROANOKE TX
76262-1149
US

IV. Provider business mailing address

101 MISSION ST STE 800
SAN FRANCISCO CA
94105-1744
US

V. Phone/Fax

Practice location:
  • Phone: 815-353-3900
  • Fax:
Mailing address:
  • Phone: 415-231-5333
  • Fax: 415-231-5332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036066189
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: