Individual
DR. JOHNNY L. LIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1611 W HARRISON ST # 400, CHICAGO, IL 60612-4861
(312) 243-4244
(312) 942-1517
Mailing address
1 WESTBROOK CORPORATE CTR, #240, WESTCHESTER, IL 60154-5701
Taxonomy
Speciality
Code
Description
License number
State
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
Primary
036115264
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036115264 1
—
IL
01
—
207067
MEDICARE PTAN NUMBER LOCALITY #16
IL
01
—
207073
MEDICARE PTAN NUMBER LOCALITY #15
IL
01
—
7686873
AETNA
IL
01
—
DA4902
RR MEDICARE PTAN NUMBER
IL
01
—
P00381332
RR MEDICARE PROVIDER NUMBER
IL
Enumeration date
05/26/2006
Last updated
04/02/2013
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