Provider Demographics
NPI:1346556339
Name:MCCUBBIN, LINDE (PA-C)
Entity Type:Individual
Prefix:
First Name:LINDE
Middle Name:
Last Name:MCCUBBIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E AUBURN RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5260
Mailing Address - Country:US
Mailing Address - Phone:248-853-2009
Mailing Address - Fax:248-853-4105
Practice Address - Street 1:215 E AUBURN RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5260
Practice Address - Country:US
Practice Address - Phone:248-853-2009
Practice Address - Fax:248-853-4105
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005815363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant