Healthcare Provider Details

I. General information

NPI: 1063037851
Provider Name (Legal Business Name): WENDY LIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2020
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W TEMPLE AVE
EFFINGHAM IL
62401-2121
US

IV. Provider business mailing address

900 W TEMPLE AVE
EFFINGHAM IL
62401-2121
US

V. Phone/Fax

Practice location:
  • Phone: 217-540-2350
  • Fax: 217-347-2323
Mailing address:
  • Phone: 217-540-2350
  • Fax: 217-347-2323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number125076958
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: