Provider Demographics
NPI:1013072313
Name:DORZAB, LINDA L (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:L
Last Name:DORZAB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3464 W 171ST ST
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:KS
Mailing Address - Zip Code:66085
Mailing Address - Country:US
Mailing Address - Phone:913-851-8669
Mailing Address - Fax:913-851-9344
Practice Address - Street 1:3464 W 171ST ST
Practice Address - Street 2:
Practice Address - City:STILWELL
Practice Address - State:KS
Practice Address - Zip Code:66085
Practice Address - Country:US
Practice Address - Phone:913-851-8669
Practice Address - Fax:913-851-9344
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0423095207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS4119451OtherAETNA
KS13308016OtherBCBS
KS0006877BMedicare ID - Type Unspecified
C50607Medicare UPIN