1235197161 NPI number — DR. LINDA ALIC MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235197161 NPI number — DR. LINDA ALIC MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

ALIC

Provider First Name:

LINDA

Provider Middle Name:

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1235197161

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

06/26/2022

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

101 MISSION ST STE 800

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

SAN FRANCISCO

Provider Business Mailing Address State Name:

CA

Provider Business Mailing Address Postal Code:

94105-1744

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

415-231-5333

Provider Business Mailing Address Fax Number:

415-231-5332

Provider First Line Business Practice Location Address:

350 DOVER LN

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

ROANOKE

Provider Business Practice Location Address State Name:

TX

Provider Business Practice Location Address Postal Code:

76262-1149

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

815-353-3900

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

05/02/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207R00000X , with the licence number:  036066189 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 036066189 . This is a "STATE LICENSE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
• Identifier: 69385-20 . This is a "STATE WISCONSIN" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
• Identifier: G173929 . This is a "STATE LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: MD46488 . This is a "STATE LICENSE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
• Identifier: 64406. . This is a "STATE LICENSE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
• Identifier: D0090539 . This is a "STATE LICENSE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 62578 . This is a "STATE LICENSE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
• Identifier: EM0001017 . This is a "STATE LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: MD187493 . This is a "STATE LICENSE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
• Identifier: 328328 . This is a "STATE LICENSE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
• Identifier: MD86840 . This is a "STATE LICENSE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
• Identifier: 88833 . This is a "STATE LICENSE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: CDR0000420 . This is a "STATE LICENSE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".