Provider Demographics
NPI:1831297548
Name:LIN, MALI (MD)
Entity Type:Individual
Prefix:DR
First Name:MALI
Middle Name:
Last Name:LIN
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 1:386 N YORK ROAD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2367
Mailing Address - Country:US
Mailing Address - Phone:630-832-6711
Mailing Address - Fax:630-832-6855
Practice Address - Street 1:386 N YORK RD
Practice Address - Street 2:SUITE 201
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2367
Practice Address - Country:US
Practice Address - Phone:630-832-6711
Practice Address - Fax:630-832-6855
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-057961207VG0400X
IL036057961207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036057961Medicaid
IL02201203OtherBLUE CROSS
IL036057961Medicaid
ILD14231Medicare UPIN