Provider Demographics
NPI:1356387559
Name:LIN, HENRY (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:
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 1:8530 LOVELAND LN
Mailing Address - Street 2:
Mailing Address - City:PALOS HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60465-1733
Mailing Address - Country:US
Mailing Address - Phone:773-994-6303
Mailing Address - Fax:773-651-7935
Practice Address - Street 1:746 W 79TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-2424
Practice Address - Country:US
Practice Address - Phone:773-994-6303
Practice Address - Fax:773-651-7935
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036046226208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036046226Medicaid
IL477350Medicare ID - Type Unspecified
IL036046226Medicaid