Provider Demographics
NPI:1700218385
Name:LIM, CAMILLA (MD)
Entity Type:Individual
Prefix:DR
First Name:CAMILLA
Middle Name:
Last Name:LIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:309 RIDGEMOOR DR
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5416
Mailing Address - Country:US
Mailing Address - Phone:630-667-8578
Mailing Address - Fax:630-323-7105
Practice Address - Street 1:309 RIDGEMOOR DR
Practice Address - Street 2:
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-5416
Practice Address - Country:US
Practice Address - Phone:630-667-8578
Practice Address - Fax:630-323-7105
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036059340207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine