Provider Demographics
NPI:1962625681
Name:LINDE, LAURA E (DPM)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:E
Last Name:LINDE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4650 SOUTHWEST HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453
Mailing Address - Country:US
Mailing Address - Phone:708-424-3201
Mailing Address - Fax:708-424-5001
Practice Address - Street 1:7450 E PINNACLE PEAK RD STE 156
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-3605
Practice Address - Country:US
Practice Address - Phone:480-563-5115
Practice Address - Fax:480-563-5132
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005240213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3991860002OtherMCR NSC
IL3991860004OtherMCR NSC
IL9817083OtherAETNA
IL3991860003OtherMCR NSC
ILP00443647OtherRR MEDICARE
ILK38617Medicare PIN