Provider Demographics
NPI:1578729182
Name:LIM, TAMARA CHUA (DO)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:CHUA
Last Name:LIM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 DEVOE DR
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-4066
Mailing Address - Country:US
Mailing Address - Phone:630-270-6651
Mailing Address - Fax:
Practice Address - Street 1:3528 E 118TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-7314
Practice Address - Country:US
Practice Address - Phone:773-646-3960
Practice Address - Fax:773-646-3955
Is Sole Proprietor?:No
Enumeration Date:2008-08-03
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036124298208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics