Provider Demographics
NPI:1083649529
Name:GO, GLEEN JOHN LIM (MD)
Entity Type:Individual
Prefix:
First Name:GLEEN
Middle Name:JOHN LIM
Last Name:GO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 160939
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32716-0939
Mailing Address - Country:US
Mailing Address - Phone:407-464-9516
Mailing Address - Fax:407-464-9519
Practice Address - Street 1:601 E ROLLINS AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803
Practice Address - Country:US
Practice Address - Phone:407-464-9516
Practice Address - Fax:407-464-9519
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME80647207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine