Provider Demographics
NPI:1548211360
Name:GROSSHEIM, LINDA DIANE (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:DIANE
Last Name:GROSSHEIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:PALM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1641 E POLSTON AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-7852
Mailing Address - Country:US
Mailing Address - Phone:208-755-2804
Mailing Address - Fax:208-765-0277
Practice Address - Street 1:910 W 5TH AVE STE 102B
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2948
Practice Address - Country:US
Practice Address - Phone:509-755-5783
Practice Address - Fax:509-459-1522
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-223762085R0001X
WI43521-0202085R0001X
IDM-142692085R0001X
WAMD608557112085R0001X
AZ649282085R0001X
CAC1725022085R0001X
GA917272085R0001X
MI43010911292085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1548211360Medicaid
ID1548211360Medicaid
WA2103992Medicaid
WI34597700Medicaid
WI34597700Medicaid
MI1548211360Medicaid