Provider Demographics
NPI:1306555644
Name:LINDER, TY M
Entity type:Individual
Prefix:
First Name:TY
Middle Name:M
Last Name:LINDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1603 STURBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44641-8786
Mailing Address - Country:US
Mailing Address - Phone:419-217-1718
Mailing Address - Fax:
Practice Address - Street 1:1603 STURBRIDGE DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:OH
Practice Address - Zip Code:44641-8786
Practice Address - Country:US
Practice Address - Phone:419-217-1718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator