Healthcare Provider Details

I. General information

NPI: 1982018305
Provider Name (Legal Business Name): DANIEL LIM D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2014
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 MAIN ST STE 400
PEORIA IL
61606-2036
US

IV. Provider business mailing address

1001 MAIN ST STE 400
PEORIA IL
61606-2036
US

V. Phone/Fax

Practice location:
  • Phone: 309-691-4005
  • Fax: 309-691-6144
Mailing address:
  • Phone: 309-691-4005
  • Fax: 309-691-6144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberOT015870
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036182190
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number036182190
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberOS020081
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: