Provider Demographics
NPI:1053526038
Name:YASSINE, LINA (MD)
Entity type:Individual
Prefix:DR
First Name:LINA
Middle Name:
Last Name:YASSINE
Suffix:
Gender:F
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:PO BOX 221317
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40252-1317
Mailing Address - Country:US
Mailing Address - Phone:502-727-3207
Mailing Address - Fax:833-422-0236
Practice Address - Street 1:1313 SAINT ANTHONY PL
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-1740
Practice Address - Country:US
Practice Address - Phone:502-727-3207
Practice Address - Fax:833-422-0236
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301079956207RE0101X
KY42177207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100095760Medicaid