Provider Demographics
NPI:1619140357
Name:MAIN, LINDA SUE (RDN)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:SUE
Last Name:MAIN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HENRY FORD HEALTH SYSTEM
Mailing Address - Street 2:ONE FORD PLACE
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202
Mailing Address - Country:US
Mailing Address - Phone:313-874-7495
Mailing Address - Fax:313-874-9515
Practice Address - Street 1:5500 AUTO CLUB DRIVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126
Practice Address - Country:US
Practice Address - Phone:313-425-4500
Practice Address - Fax:313-425-4734
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
MI133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP16800001Medicare PIN