Provider Demographics
NPI:1932604410
Name:LIN, LAWRENCE (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:LIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1336 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53172-1133
Mailing Address - Country:US
Mailing Address - Phone:414-940-0278
Mailing Address - Fax:414-301-9508
Practice Address - Street 1:725 AMERICAN AVE
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-5031
Practice Address - Country:US
Practice Address - Phone:414-940-0278
Practice Address - Fax:414-301-9508
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2024-09-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI73912-202085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology