Provider Demographics
NPI:1407968928
Name:STANLEY, LINDA K (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:K
Last Name:STANLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9 S SAINT JOSEPH AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-2846
Mailing Address - Country:US
Mailing Address - Phone:269-684-8100
Mailing Address - Fax:269-684-8261
Practice Address - Street 1:9 S SAINT JOSEPH AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-2846
Practice Address - Country:US
Practice Address - Phone:269-684-8100
Practice Address - Fax:269-684-8261
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301043549207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0801106781OtherBCBS
MION58090Medicare ID - Type Unspecified
A76527Medicare UPIN