Healthcare Provider Details

I. General information

NPI: 1326612730
Provider Name (Legal Business Name): BRENDON LIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

471 W TERRA COTTA AVE
CRYSTAL LAKE IL
60014-3434
US

IV. Provider business mailing address

4 OVERLOOK DR
HAWTHORN WOODS IL
60047-8016
US

V. Phone/Fax

Practice location:
  • Phone: 815-455-0550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number036176409
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: