Provider Demographics
NPI:1982865622
Name:LU, LIN (DO)
Entity Type:Individual
Prefix:
First Name:LIN
Middle Name:
Last Name:LU
Suffix:
Gender:M
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:PO BOX 485
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-0485
Mailing Address - Country:US
Mailing Address - Phone:765-521-1516
Mailing Address - Fax:765-599-3131
Practice Address - Street 1:1000 N 16TH ST STE 250
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-4319
Practice Address - Country:US
Practice Address - Phone:765-521-1217
Practice Address - Fax:765-521-1218
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02004621A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201298740Medicaid
IN259990011Medicare PIN