Provider Demographics
NPI:1760413272
Name:LIM, KOK H (MD)
Entity Type:Individual
Prefix:DR
First Name:KOK
Middle Name:H
Last Name:LIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LIM
Other - Middle Name:K
Other - Last Name:HOO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5177 MCCARTY LN
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-8764
Practice Address - Country:US
Practice Address - Phone:317-923-1787
Practice Address - Fax:317-962-0853
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35061850L208G00000X, 208G00000X
IN01084540A208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP0011966OtherRAILROAD MEDICARE
OH000000039033OtherANTHEM
IN074790117OtherMEDICARE
IN300063942Medicaid
OH0851065Medicaid