Provider Demographics
NPI:1093443020
Name:LINDER, MARIO A
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:A
Last Name:LINDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13504 WAINFLEET AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44135-4910
Mailing Address - Country:US
Mailing Address - Phone:216-702-9764
Mailing Address - Fax:
Practice Address - Street 1:13504 WAINFLEET AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44135-4910
Practice Address - Country:US
Practice Address - Phone:216-702-9764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist