Provider Demographics
NPI:1255376471
Name:GO-LIM, JOCELYN REDONDO (MD)
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:REDONDO
Last Name:GO-LIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JOCELYN
Other - Middle Name:REDONDO
Other - Last Name:GO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1572 S BELL SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:CHERRY VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61016-9362
Mailing Address - Country:US
Mailing Address - Phone:815-332-3015
Mailing Address - Fax:815-332-7805
Practice Address - Street 1:1572 S BELL SCHOOL RD
Practice Address - Street 2:
Practice Address - City:CHERRY VALLEY
Practice Address - State:IL
Practice Address - Zip Code:61016-9362
Practice Address - Country:US
Practice Address - Phone:815-332-3015
Practice Address - Fax:815-332-7805
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036097357207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036097357Medicaid
IL553180008Medicare PIN
ILG81054Medicare UPIN
IL036097357Medicaid
IL553180OtherMEDICARE GROUP
IL834340Medicare ID - Type UnspecifiedMEDICARE GROUP #
ILL97425Medicare ID - Type Unspecified
ILG81054Medicare UPIN
IL801290Medicare ID - Type UnspecifiedMEDICARE GROUP #
IL846930Medicare ID - Type UnspecifiedMEDICARE GROUP #
IL080148015Medicare ID - Type UnspecifiedRR INDIVIDUAL #
ILCC5050Medicare ID - Type UnspecifiedRR MEDICARE GROUP #
IL553180OtherMEDICARE GROUP #