Provider Demographics
NPI:1902243652
Name:PEITZMAN, LINDA RUTH (MD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:RUTH
Last Name:PEITZMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6641 PROMONTORY DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55346-1918
Mailing Address - Country:US
Mailing Address - Phone:952-240-5123
Mailing Address - Fax:
Practice Address - Street 1:6641 PROMONTORY DR
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55346-1918
Practice Address - Country:US
Practice Address - Phone:952-240-5123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN29402207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine