Provider Demographics
NPI:1831578988
Name:MAMMEN, LINDA (MD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:
Last Name:MAMMEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LINDA
Other - Middle Name:MAMMEN
Other - Last Name:KRAUSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:9460 E NAPIER AVE
Mailing Address - Street 2:
Mailing Address - City:BENTON HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49022-9347
Mailing Address - Country:US
Mailing Address - Phone:269-268-0109
Mailing Address - Fax:
Practice Address - Street 1:9460 E NAPIER AVE
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-9347
Practice Address - Country:US
Practice Address - Phone:269-268-0109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-22
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301067843208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics