Provider Demographics
NPI:1598282261
Name:BALISBIS, DIANA LIM (MD)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:LIM
Last Name:BALISBIS
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 1:1460 ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-2229
Mailing Address - Country:US
Mailing Address - Phone:740-622-6411
Mailing Address - Fax:
Practice Address - Street 1:1460 ORANGE ST
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-2229
Practice Address - Country:US
Practice Address - Phone:740-622-6411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.138338207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine