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NPI Code Detail

MEDICARE: DR. LINDA KOZEL HEGSTRAND M.D.

MEDICARE: DR. LINDA KOZEL HEGSTRAND 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
1207ZP0102XAnatomic Pathology & Clinical Pathology Physician4301063871MI
2208100000XPhysical Medicine & Rehabilitation Physician4301063871MI

General Provider Information

NPI Number : 1457384687
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LINDA KOZEL HEGSTRAND M.D.
Provider Business Mailing Address
First Line : 1125 CONLON AVE SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49506-3566
Country : US
Telephone Number : 616-942-6584
Fax Number : 206-350-1428
Provider Business Practice Location Address
First Line : 2426 BURTON ST SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49546-4898
Country : US
Telephone Number : 616-464-0470
Fax Number : 205-350-1428
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/09/2006
Last Update Date : 05/18/2020

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