MEDICARE: DR. JOSE DENNIS LIM M.D.

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	208D00000X	General Practice Physician	01044250A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821082090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE DENNIS LIM M.D.

Provider Business Mailing Address
First Line	:	69925 CASSOPOLIS RD
Second Line	:
City	:	EDWARDSBURG
State	:	MI
Zip	:	49112-9210
Country	:	US
Telephone Number	:	574-339-7455
Fax Number	:

Provider Business Practice Location Address
First Line	:	1901 W WESTERN AVE
Second Line	:	#B
City	:	SOUTH BEND
State	:	IN
Zip	:	46619-3521
Country	:	US
Telephone Number	:	574-234-9033
Fax Number	:	574-234-9059

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

Provider Enumeration Date	:	09/02/2005
Last Update Date	:	01/21/2009

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