Provider Demographics
NPI:1457384687
Name:HEGSTRAND, LINDA KOZEL (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:KOZEL
Last Name:HEGSTRAND
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1125 CONLON AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-3566
Mailing Address - Country:US
Mailing Address - Phone:616-942-6584
Mailing Address - Fax:206-350-1428
Practice Address - Street 1:2426 BURTON ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-4898
Practice Address - Country:US
Practice Address - Phone:616-464-0470
Practice Address - Fax:205-350-1428
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2020-05-18
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Provider Licenses
StateLicense IDTaxonomies
MI4301063871207ZP0102X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE74832Medicare UPIN