Provider Demographics
NPI:1821090606
Name:LIM, REBECCA A (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:LIM
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3998 FAIR RIDGE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2921
Mailing Address - Country:US
Mailing Address - Phone:703-293-9592
Mailing Address - Fax:703-766-9725
Practice Address - Street 1:1225 W LAKE ST
Practice Address - Street 2:WESTLAKE HOSPITAL / ANESTHESIA DEPARTMENT
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-4039
Practice Address - Country:US
Practice Address - Phone:708-681-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2015-03-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036046220207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036046220Medicaid
IL036046220Medicaid
ILIL7200001Medicare PIN