MEDICARE: LINDA GERDA BRASHEAR 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	207R00000X	Internal Medicine Physician	35079750B	OH

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

General Provider Information

NPI Number	:	1235121922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA GERDA BRASHEAR MD

Provider Business Mailing Address
First Line	:	PO BOX 1239
Second Line	:	SUITE 201
City	:	TROY
State	:	MI
Zip	:	48099-1239
Country	:	US
Telephone Number	:	248-824-6622
Fax Number	:	248-324-1477

Provider Business Practice Location Address
First Line	:	3515 MASSILLON RD
Second Line	:	SUITE 250
City	:	UNIONTOWN
State	:	OH
Zip	:	44685-6400
Country	:	US
Telephone Number	:	330-896-5651
Fax Number	:	330-896-5685

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

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	07/08/2011

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Directions to “ LINDA GERDA BRASHEAR MD” Practice Location

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