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NPI Code Detail

MEDICARE: LINDA LOU MD

MEDICARE:   LINDA  LOU  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
1207P00000XEmergency Medicine Physician4301508657MI

General Provider Information

NPI Number : 1336593912
Entity Type Code : Individual
Provider Name (Legal Business Name) : LINDA LOU MD
Provider Business Mailing Address
First Line : 12119 HIGH COUNTRY LN
Second Line :
City : LAS VEGAS
State : NV
Zip : 89138-1101
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4100 EMBASSY DR SE STE 400
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49546-2416
Country : US
Telephone Number : 616-975-1845
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2016
Last Update Date : 05/23/2023

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Directions to “ LINDA LOU MD” Practice Location

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