MEDICARE: SUSAN K LINDER MD PA

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	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician
2	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1548229164
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUSAN K LINDER MD PA

Provider Business Mailing Address
First Line	:	PO BOX 961013
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76161-0013
Country	:	US
Telephone Number	:	817-926-7671
Fax Number	:	817-926-7772

Provider Business Practice Location Address
First Line	:	2800 S HULEN ST
Second Line	:	SUITE 203
City	:	FORT WORTH
State	:	TX
Zip	:	76109-1504
Country	:	US
Telephone Number	:	817-926-7671
Fax Number	:	817-926-7772

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. SUSAN K LINDER
Credential	:	MD
Telephone Number	:	817-926-7671

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	02/26/2008

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