Provider Demographics
NPI:1285672360
Name:LINABURY, VIRGINIA M (MD)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:M
Last Name:LINABURY
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 1:250 W COVENTRY CT
Mailing Address - Street 2:SUITE 209
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-3972
Mailing Address - Country:US
Mailing Address - Phone:414-351-7726
Mailing Address - Fax:414-351-7721
Practice Address - Street 1:250 W COVENTRY CT
Practice Address - Street 2:SUITE 209
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-3972
Practice Address - Country:US
Practice Address - Phone:414-351-7726
Practice Address - Fax:414-351-7721
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI295672084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31434700Medicaid
WI3564423449EO3OtherBC/BS
WI025548Medicare ID - Type Unspecified
WI31434700Medicaid