Provider Demographics
NPI:1134251614
Name:LIM, DINNIE C (MD)
Entity type:Individual
Prefix:DR
First Name:DINNIE
Middle Name:C
Last Name:LIM
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 1:230 S HIGH ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:IL
Mailing Address - Zip Code:61944-2282
Mailing Address - Country:US
Mailing Address - Phone:217-463-5412
Mailing Address - Fax:
Practice Address - Street 1:230 S HIGH ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:IL
Practice Address - Zip Code:61944-2282
Practice Address - Country:US
Practice Address - Phone:217-463-5412
Practice Address - Fax:217-466-6994
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036088371207Q00000X
IN01043899207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02322401OtherBLUE CROSS/BLUE SHIELD
IL7208001OtherILLINOIS MEDICARE PTAN
IL036088371Medicaid
IL036088371Medicaid
F85723Medicare UPIN
IN608920Medicare PIN
IL435600Medicare PIN