Provider Demographics
NPI:1760561344
Name:MEZA, LINDA
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:
Last Name:MEZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 W ADAMS ST
Mailing Address - Street 2:UNIT 808
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2867
Mailing Address - Country:US
Mailing Address - Phone:312-850-1583
Mailing Address - Fax:312-733-5327
Practice Address - Street 1:1859 S BLUE ISLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608
Practice Address - Country:US
Practice Address - Phone:312-666-5455
Practice Address - Fax:312-733-5327
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036110283208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036110283Medicare ID - Type UnspecifiedIL LICENSE NUMBER