Provider Demographics
NPI:1477542561
Name:MUNSON, LINDA GAIL (DO)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:GAIL
Last Name:MUNSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 N OAK ST
Mailing Address - Street 2:
Mailing Address - City:WESTVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46391-9559
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:601 WALL ST
Practice Address - Street 2:PORTER STARKE SERVICES
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2512
Practice Address - Country:US
Practice Address - Phone:219-531-3662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002768A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200338090Medicaid
INH10648Medicare UPIN
IN200338090Medicaid