Basic Information
| Provider Information | |||||||||
| NPI: | 1528058195 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1220 HOBSON RD | ||||||||
| Address2: | STE 116 | ||||||||
| City: | NAPERVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605408137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6304163300 | ||||||||
| FaxNumber: | 6306465648 | ||||||||
| Practice Location | |||||||||
| Address1: | 1220 HOBSON RD | ||||||||
| Address2: | SUITE 116 | ||||||||
| City: | NAPERVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605408137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6304163300 | ||||||||
| FaxNumber: | 6306465648 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2005 | ||||||||
| LastUpdateDate: | 03/11/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 036086971 | IL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 036086971 2 | 05 | IL | MEDICAID |