Provider Demographics
NPI:1639169683
Name:GIBSON, LINDA R (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:R
Last Name:GIBSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:216 S ARLINGTON HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-1929
Mailing Address - Country:US
Mailing Address - Phone:847-221-4601
Mailing Address - Fax:847-221-4651
Practice Address - Street 1:363 W NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-2414
Practice Address - Country:US
Practice Address - Phone:847-221-4601
Practice Address - Fax:847-221-4651
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2013-07-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036-072564207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL748450OtherMEDICARE PROVIDER NUMBER
ILL31275Medicare PIN
ILD16179Medicare UPIN