MEDICARE: DR. LINDA FORTINO D.M.D.

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	122300000X	Dentist	MI11557	MI

General Provider Information

NPI Number	:	1295942597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINDA FORTINO D.M.D.

Provider Business Mailing Address
First Line	:	32931 MIDDLEBELT RD
Second Line	:	SUITE 608
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-1772
Country	:	US
Telephone Number	:	248-626-0772
Fax Number	:	248-626-3572

Provider Business Practice Location Address
First Line	:	32931 MIDDLEBELT RD
Second Line	:	SUITE 608
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-1772
Country	:	US
Telephone Number	:	248-626-0772
Fax Number	:	248-626-3572

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

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	07/08/2007

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