Provider Demographics
NPI:1689165417
Name:LIN, IRIS LEE (MD)
Entity type:Individual
Prefix:
First Name:IRIS
Middle Name:LEE
Last Name:LIN
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 1:6010 S MASON MONTGOMERY RD # 2
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-3706
Mailing Address - Country:US
Mailing Address - Phone:513-246-7027
Mailing Address - Fax:513-204-6355
Practice Address - Street 1:6010 S MASON MONTGOMERY RD # 2
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-3706
Practice Address - Country:US
Practice Address - Phone:513-246-7027
Practice Address - Fax:513-204-6355
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.145038390200000X, 2084N0400X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program