Provider Demographics
NPI:1235970880
Name:LIN, JONATHAN ANDREW (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:ANDREW
Last Name:LIN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:#4 MEMORIAL DRIVE
Mailing Address - Street 2:MEDICAL OFFICE BLDG, B, SUITE 115
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-6722
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 MEMORIAL DR
Practice Address - Street 2:MEDICAL OFFICE BLDG, A, SUITE 220
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-6722
Practice Address - Country:US
Practice Address - Phone:618-474-1723
Practice Address - Fax:618-433-6299
Is Sole Proprietor?:No
Enumeration Date:2024-06-05
Last Update Date:2025-12-19
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Provider Licenses
StateLicense IDTaxonomies
IL125.084093207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine