Provider Demographics
NPI:1245228568
Name:DIAL, LINO SEVANDAL JR (DO)
Entity Type:Individual
Prefix:
First Name:LINO
Middle Name:SEVANDAL
Last Name:DIAL
Suffix:JR
Gender:M
Credentials:DO
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Mailing Address - Street 1:5511 WEST U.S. HIGHWAY 10
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431
Mailing Address - Country:US
Mailing Address - Phone:231-843-1553
Mailing Address - Fax:231-845-5515
Practice Address - Street 1:1101 S. MISSION STREET
Practice Address - Street 2:
Practice Address - City:MT. PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858
Practice Address - Country:US
Practice Address - Phone:989-773-9700
Practice Address - Fax:989-779-9701
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2011-06-22
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Provider Licenses
StateLicense IDTaxonomies
MI5101014103207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N85680OtherMEDICARE GROUP
MI1245228568Medicaid
MI700E310160OtherBCBS GROUP
MI1245228568Medicaid