Provider Demographics
NPI:1194104885
Name:LIM, LORENZO RAY MATA (DO)
Entity type:Individual
Prefix:
First Name:LORENZO RAY
Middle Name:MATA
Last Name:LIM
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:23077 GREENFIELD RD STE 195
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3750
Mailing Address - Country:US
Mailing Address - Phone:248-423-0700
Mailing Address - Fax:248-423-0707
Practice Address - Street 1:23077 GREENFIELD RD STE 195
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3750
Practice Address - Country:US
Practice Address - Phone:248-423-0700
Practice Address - Fax:248-423-0707
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-27
Last Update Date:2018-10-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101021830207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine