Provider Demographics
NPI:1508855933
Name:LIM, SUSANA Q (MD)
Entity Type:Individual
Prefix:
First Name:SUSANA
Middle Name:Q
Last Name:LIM
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:437 HEYMANN BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2616
Mailing Address - Country:US
Mailing Address - Phone:337-289-8989
Mailing Address - Fax:337-289-8999
Practice Address - Street 1:437 HEYMANN BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2616
Practice Address - Country:US
Practice Address - Phone:337-289-8989
Practice Address - Fax:337-289-8999
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA10911R208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1998524Medicaid