Provider Demographics
NPI:1386706182
Name:LIM, JENNIFER (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:LIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1855 W TAYLOR ST
Mailing Address - Street 2:MAIL CODE 648
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-7242
Mailing Address - Country:US
Mailing Address - Phone:312-996-6500
Mailing Address - Fax:312-996-7770
Practice Address - Street 1:1855 W TAYLOR ST
Practice Address - Street 2:MAIL CODE 648
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7242
Practice Address - Country:US
Practice Address - Phone:312-996-6500
Practice Address - Fax:312-996-7770
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE53348Medicare UPIN