Healthcare Provider Details

I. General information

NPI: 1275741613
Provider Name (Legal Business Name): EDWARD V. A. LIM, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4760 E GALBRAITH RD #109
CINCINNATI OH
45236-6703
US

IV. Provider business mailing address

4760 E GALBRAITH RD #109
CINCINNATI OH
45236-6703
US

V. Phone/Fax

Practice location:
  • Phone: 513-791-5200
  • Fax: 513-791-5229
Mailing address:
  • Phone: 513-791-5200
  • Fax: 513-791-5229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35049985L
License Number StateOH

VIII. Authorized Official

Name: JANE BOSSE
Title or Position: PRAC MGR
Credential:
Phone: 513-791-5200