Healthcare Provider Details

I. General information

NPI: 1073535944
Provider Name (Legal Business Name): MICRONESIA MEDICAL & ANESTHESIA ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 S MARINE DR SUITE 126
TAMUNING GU
96913-3507
US

IV. Provider business mailing address

PO BOX 9845
TAMUNING GU
96931-5845
US

V. Phone/Fax

Practice location:
  • Phone: 671-646-8844
  • Fax: 671-646-8917
Mailing address:
  • Phone: 671-646-8844
  • Fax: 671-646-8917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberM001293
License Number StateGU
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberM001404
License Number StateGU

VIII. Authorized Official

Name: DR. REYNALD TE LIM
Title or Position: OFFICE MANAGER
Credential: M.D.
Phone: 671-646-8844