Provider Demographics
NPI:1528169729
Name:LINEHAN, ALBERT TIMOTHY IV (MD)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:TIMOTHY
Last Name:LINEHAN
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:405 N DIVISION RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-9045
Mailing Address - Country:US
Mailing Address - Phone:231-487-6575
Mailing Address - Fax:231-439-9837
Practice Address - Street 1:405 N DIVISION RD
Practice Address - Street 2:SUITE 4
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-9045
Practice Address - Country:US
Practice Address - Phone:231-487-6575
Practice Address - Fax:231-439-9837
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2011-07-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301052216207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4091246-10Medicaid
MI0302464921OtherBLUE SHIELD PIN
MI030004444OtherRAILROAD MEDICARE
MI030004444OtherRAILROAD MEDICARE
MIF04759Medicare UPIN