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Individual
LINDA C WIDMER
Active
Individual
LINDA C WIDMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036117674
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036117674
MEDICAL LICENSE
IL
05
—
036117674
—
IL
01
—
920540
MEDICARE PTAN (GROUP)
IL
01
—
920540041
MEDICARE PTAN (INDVIDUAL)
IL
Enumeration date
04/10/2007
Last updated
09/30/2013
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