Provider Demographics
NPI:1508917204
Name:MARK S LINAM DPM A PROFESSIONAL CORP.
Entity Type:Organization
Organization Name:MARK S LINAM DPM A PROFESSIONAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRISTSURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:LINAM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:562-868-0787
Mailing Address - Street 1:PO BOX 1204
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90651-1204
Mailing Address - Country:US
Mailing Address - Phone:562-868-0787
Mailing Address - Fax:562-375-6188
Practice Address - Street 1:12820 STUDEBAKER RD STE 200
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-2583
Practice Address - Country:US
Practice Address - Phone:562-868-0787
Practice Address - Fax:562-375-6188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3500213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E35000Medicaid
CAE3500Medicare PIN
CA000E35000Medicaid
CAT19334Medicare UPIN