Healthcare Provider Details

I. General information

NPI: 1548211360
Provider Name (Legal Business Name): LINDA DIANE GROSSHEIM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDA PALM

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 W 5TH AVE STE 102B
SPOKANE WA
99204-2948
US

IV. Provider business mailing address

1641 E POLSTON AVE STE 102
POST FALLS ID
83854-7852
US

V. Phone/Fax

Practice location:
  • Phone: 509-755-5783
  • Fax: 509-459-1522
Mailing address:
  • Phone: 208-755-2804
  • Fax: 208-765-0277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD-22376
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number43521-020
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberM-14269
License Number StateID
# 4
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD60855711
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number64928
License Number StateAZ
# 6
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberC172502
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number91727
License Number StateGA
# 8
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number4301091129
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: