=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669458329
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDA SUE SZABO M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/15/2005
-----------------------------------------------------
Last Update Date | 02/03/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7640 SYLVANIA AVE D1
-----------------------------------------------------
City | SYLVANIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43560-9729
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-841-4099
-----------------------------------------------------
Fax | 419-841-8125
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7640 SYLVANIA AVE D1
-----------------------------------------------------
City | SYLVANIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43560-9729
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-841-4099
-----------------------------------------------------
Fax | 419-841-8125
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 35062012
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------