Provider Demographics
NPI:1093988206
Name:LIM, MATTHEW K (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:K
Last Name:LIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 NW 70TH AVE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2911
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:150 NW 70TH AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2911
Practice Address - Country:US
Practice Address - Phone:954-583-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46175207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME46175OtherFLORIDA LICENSE
FLD58999Medicare UPIN
79967Medicare PIN