Provider Demographics
NPI:1336504281
Name:LIM, MICHAEL (PT)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:LIM
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10780 SANTA FE TRL
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-4015
Mailing Address - Country:US
Mailing Address - Phone:224-623-1599
Mailing Address - Fax:224-330-1824
Practice Address - Street 1:10780 SANTA FE TRL
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-4015
Practice Address - Country:US
Practice Address - Phone:224-623-1599
Practice Address - Fax:224-330-1824
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-18
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-014-003225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist