Provider Demographics
NPI:1568567758
Name:HUCK, LINDA A (MD)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:A
Last Name:HUCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:A
Other - Last Name:HUCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:8304 CHERINGTON DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-5920
Mailing Address - Country:US
Mailing Address - Phone:317-888-3801
Mailing Address - Fax:
Practice Address - Street 1:5908 E STOP 11 RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237
Practice Address - Country:US
Practice Address - Phone:317-497-6800
Practice Address - Fax:317-497-6801
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01031258A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100176470AMedicaid
IN718210AMedicare ID - Type Unspecified
IN100176470AMedicaid