Provider Demographics
NPI:1205241866
Name:LIM, MANDY (DO)
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:
Last Name:LIM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5111 N SCOTTSDALE RD STE 108
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-7076
Mailing Address - Country:US
Mailing Address - Phone:602-224-9218
Mailing Address - Fax:602-224-0078
Practice Address - Street 1:5111 N SCOTTSDALE RD STE 108
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85250-7076
Practice Address - Country:US
Practice Address - Phone:602-224-9218
Practice Address - Fax:602-224-0078
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-23
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10050782390200000X
AZ007353207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty