Provider Demographics
NPI:1043668015
Name:LIN, MICHELLE I (DO)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:I
Last Name:LIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3227 E WARM SPRINGS RD STE 300
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-3180
Mailing Address - Country:US
Mailing Address - Phone:702-209-3590
Mailing Address - Fax:949-404-8363
Practice Address - Street 1:3227 E WARM SPRINGS RD STE 300
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3180
Practice Address - Country:US
Practice Address - Phone:702-209-3590
Practice Address - Fax:949-404-8363
Is Sole Proprietor?:No
Enumeration Date:2016-05-31
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO2439207Q00000X
NV5L1155207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1043668015Medicaid