Healthcare Provider Details

I. General information

NPI: 1710050927
Provider Name (Legal Business Name): ALAN F.H. LIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 03/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 BURDICK EXPY W SUITE 202
MINOT ND
58701-4498
US

IV. Provider business mailing address

20 BURDICK EXPY W SUITE 202
MINOT ND
58701-4498
US

V. Phone/Fax

Practice location:
  • Phone: 701-857-5429
  • Fax: 701-839-1344
Mailing address:
  • Phone: 701-857-5429
  • Fax: 701-839-1344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number3450
License Number StateND

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier11718
Identifier TypeMEDICAID
Identifier StateND
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: