MEDICARE: DR. WALTER LIN MD, MBA

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	207R00000X	Internal Medicine Physician	A89450	CA
2	207R00000X	Internal Medicine Physician	2014018787	MO

General Provider Information

NPI Number	:	1952481913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WALTER LIN MD, MBA

Provider Business Mailing Address
First Line	:	11500 OLIVE BLVD
Second Line	:	SUITE 235
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-7143
Country	:	US
Telephone Number	:	314-925-0903
Fax Number	:

Provider Business Practice Location Address
First Line	:	11500 OLIVE BLVD
Second Line	:	SUITE 235
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-7143
Country	:	US
Telephone Number	:	314-925-0903
Fax Number	:

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

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	01/26/2016

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