Provider Demographics
NPI:1134174352
Name:LIM, RICHARD DENNIS (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:DENNIS
Last Name:LIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:75 REMITTANCE DR
Mailing Address - Street 2:SUITE 6581
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60675-6581
Mailing Address - Country:US
Mailing Address - Phone:708-226-3300
Mailing Address - Fax:708-226-4202
Practice Address - Street 1:10719 WEST 160TH STREET
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-5541
Practice Address - Country:US
Practice Address - Phone:708-226-3300
Practice Address - Fax:708-226-4202
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-091908207XS0117X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-091908OtherBLUE CROSS BLUE SHIELD PROVIDER NUMBER
ILCL4152OtherRAILROAD MEDICARE PROVIDER NUMBER
ILG31116Medicare UPIN
IL1032380001Medicare NSC