Provider Demographics
NPI:1497726749
Name:LIM, GEMMA C (MD, FACP)
Entity Type:Individual
Prefix:
First Name:GEMMA
Middle Name:C
Last Name:LIM
Suffix:
Gender:F
Credentials:MD, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 SIXTH AVE N
Mailing Address - Street 2:CENTRACARE CLINIC
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-2735
Mailing Address - Country:US
Mailing Address - Phone:320-251-2700
Mailing Address - Fax:320-762-6847
Practice Address - Street 1:1200 SIXTH AVE N
Practice Address - Street 2:CENTRACARE CLINIC
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-2735
Practice Address - Country:US
Practice Address - Phone:320-251-2700
Practice Address - Fax:320-762-6847
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN47433174400000X, 207R00000X, 208M00000X
MN117433207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No174400000XOther Service ProvidersSpecialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1043684OtherPREFERRED ONE
MN2352948OtherAMERICA'S PPO
MN276900000Medicaid
MN3300205OtherMEDICA
MN310G6LIOtherBLUE SHIELD
MNA028OtherCHAMPUS
MNHP51319OtherHEALTH PARTNERS
MN130786D277OtherUCARE
MNHP51319OtherHEALTH PARTNERS
MNA028OtherCHAMPUS
MN310G6LIOtherBLUE SHIELD