Healthcare Provider Details

I. General information

NPI: 1508775867
Provider Name (Legal Business Name): NIKOLUS LIMA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 ROCKLAND RD
LAKE BLUFF IL
60044-1778
US

IV. Provider business mailing address

644 PARADISE LN
LIBERTYVILLE IL
60048-1734
US

V. Phone/Fax

Practice location:
  • Phone: 847-535-7157
  • Fax:
Mailing address:
  • Phone: 847-204-1675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number041486801
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: