MEDICARE: MR. ROBERT MICHAEL LIM ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	96001008	IL

General Provider Information

NPI Number	:	1336117100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT MICHAEL LIM ATC

Provider Business Mailing Address
First Line	:	15124 RADAY DR
Second Line	:
City	:	MIDLOTHIAN
State	:	IL
Zip	:	60445-3745
Country	:	US
Telephone Number	:	708-824-9953
Fax Number	:

Provider Business Practice Location Address
First Line	:	6727 S CALIFORNIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-1816
Country	:	US
Telephone Number	:	773-925-8686
Fax Number	:	773-925-9587

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	07/08/2007

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