Provider Demographics
NPI:1699781138
Name:LIM, MICHAEL G (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:G
Last Name:LIM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2402 W PIERCE ST
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-3537
Mailing Address - Country:US
Mailing Address - Phone:575-887-5325
Mailing Address - Fax:575-887-6449
Practice Address - Street 1:2402 W PIERCE ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-3537
Practice Address - Country:US
Practice Address - Phone:575-887-5325
Practice Address - Fax:575-887-6449
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2011-12-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM93-313207W00000X
TXH7630207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM180016430OtherRAILROAD MEDICARE
NM06001Medicaid
NME76221Medicare UPIN
NM06001Medicaid