Provider Demographics
NPI:1629165923
Name:HUNGERFORD, LINDA ELISE (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:ELISE
Last Name:HUNGERFORD
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 1:2516 BUCKHORN RD
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:IL
Mailing Address - Zip Code:62466-4666
Mailing Address - Country:US
Mailing Address - Phone:618-839-4618
Mailing Address - Fax:
Practice Address - Street 1:2516 BUCKHORN RD
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:IL
Practice Address - Zip Code:62466-4666
Practice Address - Country:US
Practice Address - Phone:618-839-4618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360729422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC48402Medicare UPIN