MEDICARE: DR. DWIGHT PETER LIM TIU 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	208000000X	Pediatrics Physician	ME0075674	FL
2	207QA0401X	Addiction Medicine (Family Medicine) Physician	ME75674	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	43808	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154326585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DWIGHT PETER LIM TIU M.D.

Provider Business Mailing Address
First Line	:	12 FLOYD CT
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32137-8301
Country	:	US
Telephone Number	:	386-328-5437
Fax Number	:	386-447-7348

Provider Business Practice Location Address
First Line	:	1 FLORIDA PARK DR N
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32137-3852
Country	:	US
Telephone Number	:	904-728-6934
Fax Number	:	386-251-0943

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	12/20/2024

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