Provider Demographics
NPI:1912089152
Name:LIM, KELVIN O (MD)
Entity type:Individual
Prefix:
First Name:KELVIN
Middle Name:O
Last Name:LIM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:420 DELAWARE ST SE
Mailing Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0341
Mailing Address - Country:US
Mailing Address - Phone:612-273-8700
Mailing Address - Fax:
Practice Address - Street 1:2312 S 6TH ST
Practice Address - Street 2:SUITE F256 / 2B WEST
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1336
Practice Address - Country:US
Practice Address - Phone:612-273-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN439912084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1029914OtherPREFERRED ONE
MN186A0LIOtherBCBS
MN1565107OtherARAZ
MNHP34577OtherHEALTH PARTNERS
ND10387Medicaid
MN15-67637OtherMEDICA-CHOICE
MN167402OtherU CARE
MN15-67637OtherMEDICA-PRIMARY
SD7777470Medicaid
SD7777470Medicaid
MN324580200Medicare ID - Type Unspecified