Provider Demographics
NPI:1174639967
Name:LIN, CHIN TI (MD)
Entity Type:Individual
Prefix:
First Name:CHIN
Middle Name:TI
Last Name:LIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 MEADOW CREEK DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-3052
Mailing Address - Country:US
Mailing Address - Phone:810-230-0338
Mailing Address - Fax:810-230-0595
Practice Address - Street 1:330 MEADOW CREEK DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-3052
Practice Address - Country:US
Practice Address - Phone:810-230-0338
Practice Address - Fax:810-230-0595
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301036928208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4379927Medicaid
MI3402506011OtherBLUE CROSS BLUE SHIELD
MI0N99360Medicare ID - Type Unspecified
MIA74293Medicare UPIN