Provider Demographics
NPI:1194797829
Name:LIM, EDWARD VILLA (MD)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:VILLA
Last Name:LIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4460 RED BANK EXPRESSWAY
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227-2173
Mailing Address - Country:US
Mailing Address - Phone:513-791-5200
Mailing Address - Fax:513-791-5229
Practice Address - Street 1:4460 RED BANK EXPRESSWAY
Practice Address - Street 2:SUITE 110
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-2173
Practice Address - Country:US
Practice Address - Phone:513-791-5200
Practice Address - Fax:513-791-5229
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY23944207X00000X
OH35049985L207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0623150Medicaid
KY64786957Medicaid
KY64786957Medicaid
OH0623150Medicaid
OHLI4211843Medicare PIN