Healthcare Provider Details

I. General information

NPI: 1194977272
Provider Name (Legal Business Name): KARI M LIMA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 E. MAIN STREET
ELMA WA
98541-9551
US

IV. Provider business mailing address

600 E. MAIN STREET
ELMA WA
98541
US

V. Phone/Fax

Practice location:
  • Phone: 360-782-3711
  • Fax: 360-861-8675
Mailing address:
  • Phone: 360-482-3711
  • Fax: 360-861-8675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberML60017612
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: