Healthcare Provider Details

I. General information

NPI: 1003445933
Provider Name (Legal Business Name): LAURA ANN BAKER LINS MD, MPH, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 NE GLEN OAK AVE STE 301
PEORIA IL
61603-3112
US

IV. Provider business mailing address

420 NE GLEN OAK AVE STE 301
PEORIA IL
61603-3112
US

V. Phone/Fax

Practice location:
  • Phone: 309-655-7668
  • Fax: 309-655-3948
Mailing address:
  • Phone: 309-655-7668
  • Fax: 309-655-3948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036181068
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: