Provider Demographics
NPI:1649286675
Name:DAVIS, LINDA L (MD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:L
Last Name:DAVIS
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 1:1808 ABERDEEN DR
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-7600
Mailing Address - Country:US
Mailing Address - Phone:847-998-8229
Mailing Address - Fax:
Practice Address - Street 1:1808 ABERDEEN DR
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-7600
Practice Address - Country:US
Practice Address - Phone:847-998-8229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036063898207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL930014161OtherRAILROAD MEDICARE
ILC43083Medicare UPIN
C43083Medicare UPIN
ILP08931Medicare PIN
IL217091002Medicare PIN