Provider Demographics
NPI:1699804948
Name:LIM-MENESES, EMELITA (MD)
Entity type:Individual
Prefix:DR
First Name:EMELITA
Middle Name:
Last Name:LIM-MENESES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:EMELITA
Other - Middle Name:
Other - Last Name:LIM-SUERTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7 CONCORD DR
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1765
Mailing Address - Country:US
Mailing Address - Phone:773-995-9490
Mailing Address - Fax:
Practice Address - Street 1:11246 S MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-4941
Practice Address - Country:US
Practice Address - Phone:773-995-9490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01605785OtherBLUE CROSS BLUE SHIELD
IL752350Medicare ID - Type UnspecifiedMEDICARE
IL01605785OtherBLUE CROSS BLUE SHIELD