Provider Demographics
NPI:1386708105
Name:LIM, ROBERT (DPM)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:LIM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6130 S CASS AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-2623
Mailing Address - Country:US
Mailing Address - Phone:630-515-1711
Mailing Address - Fax:630-515-1706
Practice Address - Street 1:6130 S CASS AVE
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-2623
Practice Address - Country:US
Practice Address - Phone:630-515-1711
Practice Address - Fax:630-515-1706
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU17561Medicare UPIN
IL583340Medicare ID - Type Unspecified