Provider Demographics
NPI:1972745776
Name:AUBERGINE, LINDA (DO)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:AUBERGINE
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 1:19 N GRANT ST STE 3B
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3368
Mailing Address - Country:US
Mailing Address - Phone:630-634-4123
Mailing Address - Fax:
Practice Address - Street 1:19 N GRANT ST STE 3B
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3368
Practice Address - Country:US
Practice Address - Phone:630-634-4123
Practice Address - Fax:630-634-4123
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0.361286572084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry