Provider Demographics
NPI:1881865996
Name:LIN, IRENE (DO)
Entity Type:Individual
Prefix:DR
First Name:IRENE
Middle Name:
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 1:9998 CROSSPOINT BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3307
Mailing Address - Country:US
Mailing Address - Phone:317-579-2150
Mailing Address - Fax:317-579-2130
Practice Address - Street 1:9998 CROSSPOINT BLVD STE 200
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-3307
Practice Address - Country:US
Practice Address - Phone:317-579-2150
Practice Address - Fax:317-579-2130
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A 84662085R0202X
AZ0050472085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ349152Medicaid
AZZ111681Medicare PIN
AZZWCHLZMedicare PIN
AZZ121000Medicare PIN
AZZWCHLXMedicare PIN
AZZ123578Medicare PIN
AZZ121360Medicare PIN
AZZ107628Medicare PIN
AZZ123576Medicare PIN
AZZWXHQVMedicare PIN
AZZ123577Medicare PIN
AZZ113089Medicare PIN