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Individual

LINDA HIGGINBOTHAM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
211 N EDDY ST, SOUTH BEND, IN 46617-2808
(574) 237-9231
(574) 204-6355
Mailing address
211 N EDDY ST, SOUTH BEND, IN 46617-2808
(574) 237-9231
(574) 204-6355

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
01069131A
IN
207N00000X
Dermatology Physician
G53699
CA
207N00000X
Dermatology Physician
LH044277
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000699107
ANTHEM PROVIDER NUMBER
IN
01
000000733964
ANTHEM BCBS PIN
IN
01
070H263730
BCBSM/BCN
MI
01
142732
GREAT LAKES HELATH PLAN
MI
05
201035670
IN
05
3093970
MI
01
447756
AETNA
MI
01
50842
OMNICARE HEALTH PLAN
MI
Enumeration date
03/24/2006
Last updated
06/01/2018
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