Provider Demographics
NPI:1699729442
Name:CONIGLIO, LINDA PATRICIA (DO)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:PATRICIA
Last Name:CONIGLIO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5680 MARSH RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HASLETT
Mailing Address - State:MI
Mailing Address - Zip Code:48840-8987
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5680 MARSH RD
Practice Address - Street 2:SUITE 100
Practice Address - City:HASLETT
Practice Address - State:MI
Practice Address - Zip Code:48840-8987
Practice Address - Country:US
Practice Address - Phone:517-339-8251
Practice Address - Fax:517-339-9683
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007201207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2090849Medicaid
MI5333919Medicare ID - Type Unspecified
MIE26286Medicare UPIN