Healthcare Provider Details

I. General information

NPI: 1497966394
Provider Name (Legal Business Name): RIDWAN LIN MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 W SAMPLE RD STE 104
DEERFIELD BEACH FL
33064-3547
US

IV. Provider business mailing address

1700 NW 49TH ST STE 125
FORT LAUDERDALE FL
33309-3750
US

V. Phone/Fax

Practice location:
  • Phone: 954-786-5151
  • Fax: 954-786-7339
Mailing address:
  • Phone: 954-786-5151
  • Fax: 954-786-7339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License NumberME 107652
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: