Provider Demographics
NPI:1831129121
Name:DILISI, LINDA M (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:M
Last Name:DILISI
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:7255 OLD OAK BOULEVARD
Mailing Address - Street 2:SUITE C408
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3329
Mailing Address - Country:US
Mailing Address - Phone:440-414-9500
Mailing Address - Fax:216-201-5590
Practice Address - Street 1:7255 OLD OAK BOULEVARD
Practice Address - Street 2:SUITE C408
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3329
Practice Address - Country:US
Practice Address - Phone:440-414-9500
Practice Address - Fax:216-201-5590
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35072299207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2119219Medicaid
OHH044540Medicare PIN
OH2119219Medicaid