Provider Demographics
NPI:1518049097
Name:SIRUGO, LINDA S (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:S
Last Name:SIRUGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 LINCOLNWAY STE 301
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-3439
Mailing Address - Country:US
Mailing Address - Phone:219-324-2229
Mailing Address - Fax:219-324-2229
Practice Address - Street 1:1007 LINCOLNWAY
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-3201
Practice Address - Country:US
Practice Address - Phone:219-324-2229
Practice Address - Fax:219-324-2229
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01035023A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000091007OtherANTHEM
IN050058351OtherRAILROAD
IN100164100Medicaid
IN489790Medicare PIN
IN050058351OtherRAILROAD