Provider Demographics
NPI:1063481786
Name:WOODMAN, LINNETTE SUE MAIER (MD)
Entity Type:Individual
Prefix:
First Name:LINNETTE
Middle Name:SUE MAIER
Last Name:WOODMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 W WHITE RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-4988
Mailing Address - Country:US
Mailing Address - Phone:877-668-5621
Mailing Address - Fax:
Practice Address - Street 1:2600 GREENBUSH ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2479
Practice Address - Country:US
Practice Address - Phone:765-448-8000
Practice Address - Fax:765-448-8227
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045249A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN11210118OtherCAQH NUMBER
IN9397592OtherPHCS PID NUMBER
IN000000349908OtherANTHEM PROVIDER NUMBER
IN200497940Medicaid
IN200497940Medicaid
IN9397592OtherPHCS PID NUMBER
INM400015895Medicare PIN