Provider Demographics
NPI:1750360483
Name:LISTON, LINDA KAY (MD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:KAY
Last Name:LISTON
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:NORTHERN ILLINOIS UNIVERSITY HEALTH SERVICE
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-2854
Mailing Address - Country:US
Mailing Address - Phone:815-753-1311
Mailing Address - Fax:815-753-9599
Practice Address - Street 1:NORTHERN ILLINOIS UNIVERSITY
Practice Address - Street 2:HEALTH SERVICES
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-2854
Practice Address - Country:US
Practice Address - Phone:815-753-1311
Practice Address - Fax:815-753-9599
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine