Provider Demographics
NPI:1902861289
Name:LIN, MIN H (MD)
Entity Type:Individual
Prefix:DR
First Name:MIN
Middle Name:H
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 1:206 W. NIPPERSINK RD.
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60073
Mailing Address - Country:US
Mailing Address - Phone:847-546-8500
Mailing Address - Fax:847-546-4409
Practice Address - Street 1:206 W. NIPPERSINK RD.
Practice Address - Street 2:
Practice Address - City:ROUND LAKE
Practice Address - State:IL
Practice Address - Zip Code:60073
Practice Address - Country:US
Practice Address - Phone:847-546-8500
Practice Address - Fax:847-546-4409
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36045267207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36045267Medicaid
D12376Medicare UPIN
IL36045267Medicaid