MEDICARE: LINDA E DYER ERTL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	4301095760	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1417961137	OTHER	MI	BCBSM - BMH

General Provider Information

NPI Number	:	1083602924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA E DYER ERTL MD

Provider Business Mailing Address
First Line	:	601 JOHN ST
Second Line	:	SUITE E352
City	:	KALAMAZOO
State	:	MI
Zip	:	49007-5341
Country	:	US
Telephone Number	:	269-341-8986
Fax Number	:	269-341-6236

Provider Business Practice Location Address
First Line	:	601 JOHN ST
Second Line	:	SUITE E352
City	:	KALAMAZOO
State	:	MI
Zip	:	49007-5341
Country	:	US
Telephone Number	:	269-341-8986
Fax Number	:	269-341-6236

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	11/27/2023

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Directions to “ LINDA E DYER ERTL MD” Practice Location

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