Provider Demographics
NPI:1285164962
Name:LIN, JEFFREY YOUPING (DPM)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:YOUPING
Last Name:LIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13765 S SEDONA PKWY
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48906-8103
Mailing Address - Country:US
Mailing Address - Phone:517-668-6166
Mailing Address - Fax:517-668-6169
Practice Address - Street 1:13105 SCHAVEY ROAD SUITE 2
Practice Address - Street 2:
Practice Address - City:DEWITT
Practice Address - State:MI
Practice Address - Zip Code:48820-9014
Practice Address - Country:US
Practice Address - Phone:517-668-6166
Practice Address - Fax:517-668-6169
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-15
Last Update Date:2023-12-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5901002691213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5901002691Medicaid