Provider Demographics
NPI:1508939562
Name:LINN, MARTHA J (PA C)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:J
Last Name:LINN
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 CONNABLE AVE
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2212
Mailing Address - Country:US
Mailing Address - Phone:231-487-4950
Mailing Address - Fax:231-487-4951
Practice Address - Street 1:560 W MITCHELL ST
Practice Address - Street 2:STE 125
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2275
Practice Address - Country:US
Practice Address - Phone:231-487-4950
Practice Address - Fax:231-487-4951
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WY227363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI160C976180OtherBCBSM
MI160C976180OtherBCBSM
WYS97100Medicare UPIN
WYW21404Medicare PIN