MEDICARE: DR. LIN LU MD, PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	336080312	IL
2	2084P0800X	Psychiatry Physician	036119128	IL
3	2084P0800X	Psychiatry Physician	125050393	IL
4	2084P0804X	Child & Adolescent Psychiatry Physician	036.119128	IL

General Provider Information

NPI Number	:	1306045919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LIN LU MD, PHD

Provider Business Mailing Address
First Line	:	1371 GREEN KNOLLS DR
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-1147
Country	:	US
Telephone Number	:	313-506-0985
Fax Number	:	913-613-0778

Provider Business Practice Location Address
First Line	:	830 W END CT STE 400
Second Line	:
City	:	VERNON HILLS
State	:	IL
Zip	:	60061-1344
Country	:	US
Telephone Number	:	847-247-6910
Fax Number	:	847-247-6950

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2007
Last Update Date	:	03/20/2023

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