Provider Demographics
NPI:1174596548
Name:MILHOLEN, LINDA S (MD)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:S
Last Name:MILHOLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 109
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:MO
Mailing Address - Zip Code:65483-0109
Mailing Address - Country:US
Mailing Address - Phone:417-399-4707
Mailing Address - Fax:
Practice Address - Street 1:10981 HIGHWAY 63
Practice Address - Street 2:
Practice Address - City:LICKING
Practice Address - State:MO
Practice Address - Zip Code:65542-9869
Practice Address - Country:US
Practice Address - Phone:417-399-4707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001029380208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1174596548Medicaid
MOP00171332OtherRAILROAD MEDICARE
MO205687908Medicaid
MO000015225Medicare PIN
MOP00171332OtherRAILROAD MEDICARE
C73699Medicare UPIN
MO132300045Medicare PIN