Provider Demographics
NPI:1154482438
Name:PEARSON, LINDEN R (MD)
Entity Type:Individual
Prefix:
First Name:LINDEN
Middle Name:R
Last Name:PEARSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4230 LINCOLNSHIRE DR STE G
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-2189
Mailing Address - Country:US
Mailing Address - Phone:618-244-6770
Mailing Address - Fax:618-244-6772
Practice Address - Street 1:4230 LINCOLNSHIRE DR STE G
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-2189
Practice Address - Country:US
Practice Address - Phone:618-244-6770
Practice Address - Fax:618-244-6772
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036063418207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL174857OtherHEALTHLINK PPO HMO
IL04127526OtherBCBS
IL036063418Medicaid
IL080168274OtherMEDICARE RAILROAD NUMBER
IL036063418Medicaid
IL080168274OtherMEDICARE RAILROAD NUMBER