Provider Demographics
NPI:1356389381
Name:LIMA, ALEX (MD)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:
Last Name:LIMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2834 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-7401
Mailing Address - Country:US
Mailing Address - Phone:773-772-1139
Mailing Address - Fax:773-772-9260
Practice Address - Street 1:2834 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-7401
Practice Address - Country:US
Practice Address - Phone:773-772-1139
Practice Address - Fax:773-772-9260
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036110332207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01622957OtherBLUE SHIELD GROUP #
IL036110332Medicaid
ILK41060Medicare PIN