MEDICARE: DR. JIM LIMPERIS D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry		IL

General Provider Information

NPI Number	:	1053485482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JIM LIMPERIS D.M.D.

Provider Business Mailing Address
First Line	:	2309 MOHAWK LN
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60026-1035
Country	:	US
Telephone Number	:	847-564-5434
Fax Number	:

Provider Business Practice Location Address
First Line	:	3207 LAKE AVE
Second Line	:
City	:	WILMETTE
State	:	IL
Zip	:	60091-1082
Country	:	US
Telephone Number	:	847-256-1900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	07/08/2007

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