Provider Demographics
NPI:1386919538
Name:LIM, DIOSDADO T (MD)
Entity type:Individual
Prefix:
First Name:DIOSDADO
Middle Name:T
Last Name:LIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7520 W. UTE LN
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-2076
Mailing Address - Country:US
Mailing Address - Phone:708-361-4803
Mailing Address - Fax:708-361-4803
Practice Address - Street 1:7520 W. UTE LN
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-2076
Practice Address - Country:US
Practice Address - Phone:708-361-4803
Practice Address - Fax:708-361-4803
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036043145207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL12494Medicare UPIN