Provider Demographics
NPI:1679617419
Name:LINDA M DUBAY MD PLLC
Entity type:Organization
Organization Name:LINDA M DUBAY MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DUBAY
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:248-662-4333
Mailing Address - Street 1:26850 PROVIDENCE PKWY
Mailing Address - Street 2:STE 504
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-1213
Mailing Address - Country:US
Mailing Address - Phone:248-662-4333
Mailing Address - Fax:248-662-3022
Practice Address - Street 1:26850 PROVIDENCE PKWY
Practice Address - Street 2:STE 504
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1213
Practice Address - Country:US
Practice Address - Phone:248-662-4333
Practice Address - Fax:248-662-3022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILD053074208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI103881OtherGREAT LAKES
MI312461OtherPRORITY HEALTH
MI1679617419Medicaid
MI020F369860OtherBCBS GROUP
MI0206368471OtherBC
MI0206368471OtherBCN
MIF57526OtherHAP
MI020F369860OtherBCN GROUP
MI025832OtherMIDWEST HEALTH PLAN
MI4361872OtherAETNA
MI112457004OtherUNITED HEALTH PLAN
MIDP1484OtherRAILROAD MEDICARE
MI312461OtherPRORITY HEALTH
MIF57526Medicare UPIN