Basic Information
| Provider Information | |||||||||
| NPI: | 1760708267 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LIN | ||||||||
| FirstName: | BERTINA | ||||||||
| MiddleName: | FINWEI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 HIGHLANDER POINT DR | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | FLOYDS KNOBS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471199465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8125424921 | ||||||||
| FaxNumber: | 8129495966 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 HIGHLANDER POINT DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | FLOYDS KNOBS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471199465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8129232273 | ||||||||
| FaxNumber: | 8129234100 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2010 | ||||||||
| LastUpdateDate: | 03/03/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 01074828A | IN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 201268490 | 05 | IN | MEDICAID |