Provider Demographics
NPI:1750314035
Name:SAMBORN, LINDA (DO)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:
Last Name:SAMBORN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 WOODSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:ESSEXVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48732-1234
Mailing Address - Country:US
Mailing Address - Phone:989-892-7722
Mailing Address - Fax:989-892-7455
Practice Address - Street 1:4175 N EUCLID AVE STE 3
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2483
Practice Address - Country:US
Practice Address - Phone:989-667-0491
Practice Address - Fax:989-667-0493
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011227207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0Z91029OtherBCBS
MI1007493OtherMCLAREN
MI233873OtherRIVERBEND
MI4983950Medicaid
MIAF09001OtherMCARE
MILS011227OtherBCBS
MI010Z911030OtherBLUE CROSS BLUE SHIELD
MI233866OtherRIVERBEND
MI0P43930OtherMEDICARE GROUP
MI010Z960170OtherBLUE CROSS BLUE SHIELD
MI0F51019OtherBCBS
MI4279897Medicaid
MI4303974Medicaid
MI4601967Medicaid
MIE82049Medicare UPIN
MIOZ96017090Medicare PIN
MI010Z960170OtherBLUE CROSS BLUE SHIELD
MI4303974Medicaid
MI4279897Medicaid