MEDICARE: DR. LINDA R. GIBSON 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	207VG0400X	Gynecology Physician	036-072564	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	748450	OTHER	IL	MEDICARE PROVIDER NUMBER

General Provider Information

NPI Number	:	1639169683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINDA R. GIBSON M.D.

Provider Business Mailing Address
First Line	:	216 S ARLINGTON HEIGHTS RD
Second Line	:
City	:	ARLINGTON HTS
State	:	IL
Zip	:	60005-1929
Country	:	US
Telephone Number	:	847-221-4601
Fax Number	:	847-221-4651

Provider Business Practice Location Address
First Line	:	363 W NORTHWEST HWY
Second Line	:
City	:	PALATINE
State	:	IL
Zip	:	60067-2414
Country	:	US
Telephone Number	:	847-221-4601
Fax Number	:	847-221-4651

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

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	07/25/2013

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Directions to “ DR. LINDA R. GIBSON M.D.” Practice Location

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