Provider Demographics
NPI:1760708267
Name:LIN, BERTINA FINWEI
Entity Type:Individual
Prefix:
First Name:BERTINA
Middle Name:FINWEI
Last Name:LIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 HIGHLANDER POINT DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:FLOYDS KNOBS
Mailing Address - State:IN
Mailing Address - Zip Code:47119-9465
Mailing Address - Country:US
Mailing Address - Phone:812-542-4921
Mailing Address - Fax:812-949-5966
Practice Address - Street 1:800 HIGHLANDER POINT DR
Practice Address - Street 2:SUITE 300
Practice Address - City:FLOYDS KNOBS
Practice Address - State:IN
Practice Address - Zip Code:47119-9465
Practice Address - Country:US
Practice Address - Phone:812-923-2273
Practice Address - Fax:812-923-4100
Is Sole Proprietor?:No
Enumeration Date:2010-04-09
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01074828A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201268490Medicaid
IN201268490Medicaid