Healthcare Provider Details

I. General information

NPI: 1285672360
Provider Name (Legal Business Name): VIRGINIA M. LINABURY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 W COVENTRY CT SUITE 209
GLENDALE WI
53217-3972
US

IV. Provider business mailing address

250 W COVENTRY CT SUITE 209
GLENDALE WI
53217-3972
US

V. Phone/Fax

Practice location:
  • Phone: 414-351-7726
  • Fax: 414-351-7721
Mailing address:
  • Phone: 414-351-7726
  • Fax: 414-351-7721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number29567
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: