Provider Demographics
NPI:1982850111
Name:LIN, MICHAEL WYSHIEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WYSHIEN
Last Name:LIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10800 E GEDDES AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3895
Mailing Address - Country:US
Mailing Address - Phone:303-761-9190
Mailing Address - Fax:720-874-4462
Practice Address - Street 1:501 E HAMPDEN AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2702
Practice Address - Country:US
Practice Address - Phone:303-761-9190
Practice Address - Fax:720-874-4462
Is Sole Proprietor?:No
Enumeration Date:2008-08-07
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL1250522872085R0202X
KS04-364622085R0202X
NE265642085R0202X
HIMD174752085R0202X
CO506862085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200876590AMedicaid
CO38752361Medicaid
WY1982850111Medicaid
MT1982850111Medicaid
AZ764062Medicaid
NM46554033Medicaid
COP01106666Medicare PIN
KS200876590AMedicaid
MT1982850111Medicaid
NM46554033Medicaid
CO38752361Medicaid
COCOA107469Medicare PIN
CO395152ZLJ3Medicare PIN
KSKA3249045Medicare PIN
COCOA107471Medicare PIN