Provider Demographics
NPI:1235197161
Name:ALIC, LINDA (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:
Last Name:ALIC
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 1:101 MISSION ST STE 800
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94105-1744
Mailing Address - Country:US
Mailing Address - Phone:415-231-5333
Mailing Address - Fax:415-231-5332
Practice Address - Street 1:350 DOVER LN
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:TX
Practice Address - Zip Code:76262-1149
Practice Address - Country:US
Practice Address - Phone:815-353-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2022-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036066189207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036066189OtherSTATE LICENSE
WI69385-20OtherSTATE WISCONSIN
CAG173929OtherSTATE LICENSE
IAMD46488OtherSTATE LICENSE
TN64406.OtherSTATE LICENSE
MDD0090539OtherSTATE LICENSE
AZ62578OtherSTATE LICENSE
MIEM0001017OtherSTATE LICENSE
ORMD187493OtherSTATE LICENSE
LA328328OtherSTATE LICENSE
SCMD86840OtherSTATE LICENSE
GA88833OtherSTATE LICENSE
COCDR0000420OtherSTATE LICENSE