Provider Demographics
NPI:1225027311
Name:LIM, CARMELITA BAUTISTA (MD)
Entity Type:Individual
Prefix:
First Name:CARMELITA
Middle Name:BAUTISTA
Last Name:LIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5909 US HWY 27 N
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-1218
Mailing Address - Country:US
Mailing Address - Phone:863-382-4040
Mailing Address - Fax:863-382-3533
Practice Address - Street 1:5909 US HWY 27 N
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-1218
Practice Address - Country:US
Practice Address - Phone:863-382-4040
Practice Address - Fax:863-382-3533
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50046207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008316900Medicaid
FL04133ZMedicare UPIN
FL008316900Medicaid