Provider Demographics
NPI:1376566281
Name:LIN, JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:LIN
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:101 WAUKEGAN RD
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-3012
Mailing Address - Country:US
Mailing Address - Phone:847-295-8500
Mailing Address - Fax:847-295-8501
Practice Address - Street 1:101 WAUKEGAN RD
Practice Address - Street 2:SUITE 1200
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044-3012
Practice Address - Country:US
Practice Address - Phone:847-295-8500
Practice Address - Fax:847-295-8501
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036094142207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC44858Medicare UPIN