Provider Demographics
NPI:1952363921
Name:LINZ, GEOFFREY M (MD)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:M
Last Name:LINZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 S BALLENGER HWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3638
Mailing Address - Country:US
Mailing Address - Phone:810-342-1000
Mailing Address - Fax:810-342-1590
Practice Address - Street 1:2316 S CEDAR ST
Practice Address - Street 2:SUITE 500
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-3152
Practice Address - Country:US
Practice Address - Phone:517-702-4350
Practice Address - Fax:517-702-4359
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301038240207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MICA9749 POO359OtherMETRAHEALTH
MI252806OtherMHP HAN
MI3329658Medicaid
MI40-00420OtherPHP
MI252806OtherMHP HAN
MICA9749 POO359OtherMETRAHEALTH