Provider Demographics
NPI:1407900194
Name:LINEHAN, COLLEEN ANNE (MD)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:ANNE
Last Name:LINEHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:ANNE
Other - Last Name:MALEK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1447 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4727
Mailing Address - Country:US
Mailing Address - Phone:989-583-7450
Mailing Address - Fax:989-583-7452
Practice Address - Street 1:900 COOPER AVE
Practice Address - Street 2:SUITE 3100
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-5182
Practice Address - Country:US
Practice Address - Phone:989-583-7450
Practice Address - Fax:989-583-7452
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN46380207X00000X
MICL089052207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
20-0G311050OtherBCBS GRP
01007578OtherHPM
0731284OtherBCBS
CL089052OtherSTATE ID
102620OtherUPIN
5180912OtherM-CAID
OP07120-008OtherM-CARE