Provider Demographics
NPI:1790897288
Name:BREVITZ, LINDA S (DO)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:S
Last Name:BREVITZ
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:MS21110Q
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:800-968-6866
Mailing Address - Fax:616-532-7230
Practice Address - Street 1:640 JACKSON ST
Practice Address - Street 2:HP REGIONS BEHAVIORAL HEALTH
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2502
Practice Address - Country:US
Practice Address - Phone:651-254-4786
Practice Address - Fax:651-254-9426
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-02-16
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Provider Licenses
StateLicense IDTaxonomies
MI51010132522084P0800X
MN503842084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4924716Medicaid
LB013252OtherBLUE CROSS BLUE SHIELD
LB013252OtherBLUE CROSS BLUE SHIELD
MI0P41930005Medicare Oscar/Certification