Provider Demographics
NPI:1942326905
Name:BOXUM, LINDA NOWZARADAN (DO)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:NOWZARADAN
Last Name:BOXUM
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 1:754 MCCOOL ROAD
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-8856
Mailing Address - Country:UM
Mailing Address - Phone:219-759-5500
Mailing Address - Fax:
Practice Address - Street 1:754 MCCOOL RD
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385-8856
Practice Address - Country:US
Practice Address - Phone:219-759-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002922A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200860720AMedicaid
IN000000524371OtherANTHEM BCBS PIN
IN000000524371OtherANTHEM BCBS PIN
INP00437948Medicare PIN