Basic Information
Provider Information
NPI: 1750538880
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LINN
FirstName: JOHN
MiddleName: GRIFFITH
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2050 PFINGSTEN RD STE 128
Address2:  
City: GLENVIEW
State: IL
PostalCode: 600261324
CountryCode: US
TelephoneNumber: 8475701700
FaxNumber: 8477335293
Practice Location
Address1: 2050 PFINGSTEN RD STE 128
Address2:  
City: GLENVIEW
State: IL
PostalCode: 60026
CountryCode: US
TelephoneNumber: 8475701700
FaxNumber: 8477335293
Other Information
ProviderEnumerationDate: 08/20/2008
LastUpdateDate: 10/13/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/13/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208600000X036127792ILY Allopathic & Osteopathic PhysiciansSurgery 

No ID Information.


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