Provider Demographics
NPI:1770345258
Name:DBOUK, LINDA (PA)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:DBOUK
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26210 N RIVER PARK DR
Mailing Address - Street 2:
Mailing Address - City:INKSTER
Mailing Address - State:MI
Mailing Address - Zip Code:48141-1918
Mailing Address - Country:US
Mailing Address - Phone:586-819-9398
Mailing Address - Fax:
Practice Address - Street 1:4420 E DAVISON ST
Practice Address - Street 2:
Practice Address - City:HAMTRAMCK
Practice Address - State:MI
Practice Address - Zip Code:48212-1744
Practice Address - Country:US
Practice Address - Phone:313-369-1500
Practice Address - Fax:313-369-1205
Is Sole Proprietor?:No
Enumeration Date:2024-01-29
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601012085363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant