Provider Demographics
NPI:1386792091
Name:LINDEN, MICHAEL D (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:LINDEN
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 1:14370 VIA VENEZIA
Mailing Address - Street 2:1201
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-1661
Mailing Address - Country:US
Mailing Address - Phone:734-389-5496
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-1672
Practice Address - Country:US
Practice Address - Phone:336-716-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG88743207ZP0102X
MI4301057165207ZP0102X
NC2018-01123207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ML057165OtherCOMMERCIAL-COMMERCIAL NUMBER
ML057165OtherCHAMPUS-CHAMPUS
MI269035010Medicaid
CAG88743OtherMEDICAL BOARD OF CA
700H262270OtherBLUE CROSS-BLUE CROSS
CAG88743OtherMEDICAL BOARD OF CA
ML057165OtherCHAMPUS-CHAMPUS