Provider Demographics
NPI:1396793964
Name:LIN, SHIANN C (MD)
Entity type:Individual
Prefix:MR
First Name:SHIANN
Middle Name:C
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 1:316 CIRCLE AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130-1610
Mailing Address - Country:US
Mailing Address - Phone:708-366-0145
Mailing Address - Fax:708-366-7450
Practice Address - Street 1:316 CIRCLE AVE
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:IL
Practice Address - Zip Code:60130-1610
Practice Address - Country:US
Practice Address - Phone:708-366-0145
Practice Address - Fax:708-366-7450
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
467800Medicare ID - Type Unspecified
D12481Medicare UPIN