Provider Demographics
NPI:1164604351
Name:KAHN, LINDA (PA)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:KAHN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:551 LINN ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ALLEGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49010-1595
Mailing Address - Country:US
Mailing Address - Phone:269-686-5800
Mailing Address - Fax:269-686-5899
Practice Address - Street 1:551 LINN ST
Practice Address - Street 2:SUITE 150
Practice Address - City:ALLEGAN
Practice Address - State:MI
Practice Address - Zip Code:49010-1595
Practice Address - Country:US
Practice Address - Phone:269-686-5800
Practice Address - Fax:269-686-5899
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601001730363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P39040040Medicare PIN