Healthcare Provider Details

I. General information

NPI: 1285812438
Provider Name (Legal Business Name): ANGELA S. LIMA S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2008
Last Update Date: 02/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6733 KINGERY HWY
WILLOWBROOK IL
60527-5142
US

IV. Provider business mailing address

429 S PECK AVE
LA GRANGE IL
60525-6127
US

V. Phone/Fax

Practice location:
  • Phone: 630-850-0600
  • Fax: 630-850-0608
Mailing address:
  • Phone: 708-579-9223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. ANGELA S. LIMA
Title or Position: AGENT
Credential: D.O.
Phone: 708-579-9223